Quality Measures Used to Assess Care, Improve Outcomes in Children, Adults with Rheumatic Diseases

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WASHINGTON, D.C.—In a session during the 2016 ACR/ARHP Annual Meeting, aptly called Quality Measures and Quality of Care I, a panel of experts presented information on a number of programs underway in rheumatology using quality measures to both assess and improve patient outcomes. Leading off were two presentations on programs using quality measures to improve outcomes for children with rheumatologic diseases, followed by presentations on programs geared toward adult patients.

Juvenile Idiopathic Arthritis

April Bingham, MD, a pediatric rheumatologist and assistant professor at Penn State Children’s Hospital in Hershey, Pa., provided an update on the effectiveness of the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) to improve outcomes of care for children with rheumatic disease.

Created in 2011, PR-COIN is a multi-center quality improvement learning network that engages patients/families and healthcare providers with the ultimate aim of improving clinical outcomes for children with rheumatic disease, with an initial focus on juvenile idiopathic arthritis (JIA). Centers involved with the network apply proven quality improvement (QI) methodology to conduct QI work and share clinical data on their JIA patients to track performance on process and outcome quality measures.

Currently, 18 centers are involved in the network. As of May 2016, 4,722 patients with JIA were enrolled in the network with more than 28,000 visits recorded in the registry.

Dr. Bingham presented data showing an improvement in performance quality measures beginning in 2011 by participating member centers. These include improvement in the percentage of patients on disease-modifying anti-rheumatic drugs (DMARDs) who were lab monitored for toxicity (49–78%); improvement in the number of patients who had functional assessments (33–84%); and improvement in the percentage of patients who received medication counseling when starting DMARDs (14–75%).

In addition, participants in PR-COIN have reliably demonstrated high performance on a number of quality measures, including physician global assessment of disease activity, measurement of arthritis-related pain, performance of complete joint counts and tuberculosis screening for patients initiating a biologic agent.

“What is most exciting is that, as a network, PR-COIN has measurably improved Juvenile Arthritis Disease Activity Scores and the percentage of JIA patients with clinical inactive disease,” said Dr. Bingham, adding that “through participation in PR-COIN, pediatric rheumatology care providers are more reliably providing quality care and improving outcomes for children with [JIA].”

JIA & Uveitis

In a second presentation on JIA, Laura Ballenger, MD, pediatric resident at Nationwide Children’s Hospital, Columbus, Ohio, described barriers to uveitis screening for JIA patients for rheumatologists to be aware of to help improve adherence to recommended uveitis screening guidelines.