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Rheumatoid Arthritis Quality Indicators

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The ACR has endorsed seven RA quality indicators.

Five were developed or included as part of a 2008 QI development project commissioned by CMS and led by the National Committee for Quality Assurance and the AMA Physician Consortium for Quality Improvement, with significant ACR involvement at the invitation of the NCQA and AMA. The measure descriptions are listed below.

Rheumatoid Arthritis: Tuberculosis Screening

Percentage of patients 18 years and older with a diagnosis of rheumatoid arthritis who have documentation of a tuberculosis (TB) screening performed and results interpreted within 6 months prior to receiving a first course of therapy using a biologic disease-modifying antirheumatic drug (DMARD).

Rheumatoid Arthritis: Periodic Assessment of Disease Activity

Percentage of patients 18 years and older with a diagnosis of rheumatoid arthritis who have an assessment and classification of disease activity at least once within 12 months.

Rheumatoid Arthritis: Functional Status Assessment

Percentage of patients 18 years and older with a diagnosis of rheumatoid arthritis for whom a functional status assessment was performed at least once within twelve months.

Rheumatoid Arthritis: Assessment and Classification of Disease Prognosis

Percentage of patients 18 years and older with a diagnosis of rheumatoid arthritis who have an assessment and classification of disease prognosis at least once within 12 months.

Rheumatoid Arthritis: Glucocorticoid Management

Percentage of patients 18 years and older with a diagnosis of rheumatoid arthritis who have been assessed for glucocorticoid use and, for those on prolonged doses of prednisone > 10 mg daily (or equivalent) with improvement or no change in disease activity, documentation of glucocorticoid management plan within 12 months

To see the full measure set with specifications and references, click here.

The two other RA measures that have been endorsed by the ACR are as follows:

Rheumatoid Arthritis: Treatment

IF a patient has an established diagnosis of rheumatoid arthritis, THEN the patient should be treated with a DMARD* unless contraindication to DMARD*, inactive disease or patient refusal is documented.

Rheumatoid Arthritis: Treatment

IF a patient has rheumatoid arthritis and is being treated with a DMARD* and there is evidence of increased disease activity or there is evidence of progression of RA bony damage over a 6-month period of time, THEN one of the following should be done: change DMARD* dose or route of administration, change DMARD*, add an additional DMARD*, start or increase dose of glucocorticoids or provide local glucocorticoid injection(s), unless the patient refuses or all of the above are contraindicated.

*DMARD = disease modifying antirheumatic drug, including abatacept, adalimumab, anakinra, azathioprine, cyclosporine, etanercept, gold (oral or intramuscular), hydroxychloroquine, infliximab, leflunomide, methotrexate, minocycline, rituximab and sulfasalazine.

References (for the last two measures listed above)

Arthritis Foundation Quality Indicator Project
Khanna D, Arnold E, Pencharz JN, Grossman JM, Traina SB, Lal A, MacLean CH. Measuring Process of Arthritis Care: The Arthritis Foundation's Quality Indicator Set for Rheumatoid Arthritis. Semin Arthritis Rheum. 2006;35:211-37.

MacLean CH, Saag KG, Solomon DH, Morton SC, Sampsel S, Klippel JH. Measuring Quality in Arthritis Care: Methods for Developing the Arthritis Foundation's Quality Indicator Set. Arthritis Rheum. 2004;51:193-202.

British Society for Rheumatology/ Royal College of Physicians
Guideline and audit measures for specialist supervision of patients with rheumatoid arthritis. Report of a Joint Working Group of the British Society for Rheumatology and the Research Unit of the Royal College of Physicians. J Royal College of Physicians of London 1992;26(1):76-82. www.rheumatology.org.uk.

National Committee for Quality Assurance / HEDIS
HEDIS® 2006 Technical Specifications. Disease Modifying Anti-rheumatic Drug Therapy in Rheumatoid Arthritis. Washington, DC. 2005. 160-1.