Although the concept of clinical registries isn’t new, registries are emerging throughout medicine and with increasing frequency. Their intended uses span quality improvement, public health monitoring, clinical and health services research, and postmarket surveillance. Considering the current political and professional environment, this rapid growth of registries is somewhat predictable. Physicians are practicing in a time of ever-increasing focus on quality measurement and improvement in healthcare (perhaps most obviously illustrated by the recent nomination of Donald Berwick, MD, [quoted above] as the CMS administrator); dramatic expansion of health information technology (HIT), in terms of capabilities and penetration throughout clinical care settings; and recognition that many clinical questions aren’t well addressed through the current clinical trials infrastructure (e.g., the comparative effectiveness of interventions). All of these factors push registry development.
Recently, the medical profession has embraced the concept of evidence-based medicine as central to high-quality healthcare. Evidence-based care is informed by findings of rigorous clinical research and then applied “at the bedside” with skillful interpretation that takes into account numerous treatment options as well as the individual patient’s health, social context, and preferences. This individualized, real-world care is influenced by the expertise of the physician and the local system in which he or she practices.
As such, descriptions of national trends or the results of interventions administered in the controlled research setting do not necessarily translate perfectly to your own practice. It’s unlikely that these findings provide a meaningful roadmap for your practice improvement efforts. This fundamental fact is one of the driving forces of improvement-focused registries. Being a better doctor, providing the best care, and contributing to a fiscally healthy practice require continuing education, ongoing data collection, and a culture focused on improvement.
The ACR has been firmly committed to the concepts of quality care delivery and continuous quality improvement through programs such as our practice guidelines and practice improvement modules (PIMs), along with our overall focus on education and training. Since 2004, the ACR has been closely evaluating the continued maturation of the “quality field” and the movement by employers, private payers, and the Centers for Medicare and Medicaid Services (CMS) to require healthcare professionals to document that they meet quality standards and demonstrate quality improvement. With the passage of healthcare reform, the need to document these efforts will accelerate.
To that end, I feel it is important that our members know fully about ACR efforts in assisting our members in meeting these new professional expectations. Earlier this year, the ACR hired Kristen McNiff, MPH, as vice president of the new Registry, Quality, and Healthcare Informatics Department. She brings a decade of experience in this arena, having been a major force in the quality efforts of the American Society of Clinical Oncology (ASCO) and the development of its successful registry. In this month’s “President’s Perspective,” I asked Kristen to provide her thoughts and vision on the ACR’s present and future efforts regarding our registry development. I think you will be impressed with the efforts to date and the future plans to ensure that our members have the proper tools to function in a changing healthcare environment.
—Stanley B. Cohen, MD
Web-based system will ease compliance with PQRI, benchmarking, research
Rheumatologists practicing in the current healthcare environment are experiencing unprecedented information flow, data management issues, and a rise in quality designations and pay-for-performance incentive programs. There is increasing pressure on rheumatologists to document or capture treatment concordance with guideline recommendations and best practices and to monitor gaps in care and patient outcomes. Unfortunately, some quality programs are not considered clinically meaningful, and even those that are often bring administrative burdens related to reporting, data aggregation, and analysis.
Expanded opportunities to advance rheumatology will be offered by ACR’s ongoing registry efforts
AIM:RA is a web-based self-evaluation of practice performance tool designed to guide a physician through medical-chart data abstraction using a series of questions related directly to evidence-based quality indicators.