The implementation of a bundle of quality measures for rheumatoid arthritis (RA) helped identify gaps in care delivery, and another quality improvement study resulted in increased safety of intravenous infusions at a pediatric rheumatology practice. These abstracts were among six presented at a session titled, “Quality Measures and Innovations in Practice Management and Care Delivery I,” here at the 2011 ACR/ARHP Annual Scientific Meeting in Chicago in November. [Editor’s note: First session (Walker) was recorded and is available via ACR SessionSelect at www.rheumatology.org.]
Quality Measure Tool
Chad P. Walker, DO, a second-year rheumatology fellow at Geisinger Medical Center in Danville, Pa., presented the results of implementing an RA quality-measure bundle that focused on improving disease activity, medication safety, and comorbid hyperlipidemia in nearly 1,700 patients with RA. He defined a quality bundle as “different care processes and protocols.” Rheumatologists at Geisinger agreed to be held accountable for the selected quality measures.
By systematically and electronically capturing both physician and patient data and subsequently studying the measures, Dr. Walker and his team identified gaps in care. “We have to start rethinking how we deliver care and understand the importance of quality,” he said.
The Geisinger team tracked not just the percentage of patients receiving a disease-modifying antirheumatic drug but also the percentage of these patients whose RA was at low disease activity. They used the Clinical Disease Activity Index to assess disease activity, with a score of less than 10 considered low activity. Fewer than 30% of patients met that stringent metric, which Dr. Walker says indicates room for improvement.
Additionally, the researchers measured the percentage of patients older than 45 years who had their low-density lipoprotein (LDL) cholesterol checked within the previous five years. They also calculated the percentage of those patients whose LDL level met the nationwide recommendation of less than 130 mg/dL. Only 78% of patients who needed cholesterol screening met this goal, although 92% of the applicable cohort had an LDL test, said Dr. Walker.
The electronic system’s task management reports for each care provider encouraged “transparent reporting,” he added.
At Cincinnati Children’s Hospital Medical Center, an accidental medication error during an intravenous infusion was a precursor event that was “capable of inciting change on an organizational level,” according to presenter Pai-Yue (“Patty”) Lu, MD, a pediatric rheumatology fellow there. “This event occurred while initiatives to improve the safe delivery of intravenous infusions were ongoing, and reinforced the need to step up interventions,” she said.