THU0630\u2005THE ACR’S RHEUMATOLOGY INFORMATICS SYSTEM FOR EFFECTIVENESS (RISE) DEMONSTRATES IMPROVEMENTS IN MANY MEASURES OF QUALITY OF CARE BETWEEN 2016 AND 2017

Abstract

Background: The ACR’s Rheumatology Informatics System for Effectiveness (RISE) is a national, EHR-enabled registry that passively collects data on all patients seen by participating practices, thus reducing the selection bias present in single-insurer claims databases. Launched in 2014, RISE is designed to help practices improve their quality of care. Objectives: The objectives of our study were to a) examine changes in practice-level performance on selected quality measures for patients with rheumatoid arthritis (RA) in 2016 and 2017 and b) assess variations in performance over time between practices. Methods: We analyzed data collected on all patients with a diagnosis of RA who had at least one clinic visit between January 1, 2016 and December 31, 2017. Six quality measures in the areas of RA management (disease activity measurement and tuberculosis (TB) screening), and cardiovascular risk reduction (body mass index (BMI) screening in 18-64 years, BMI screening in >64 years, tobacco use screening and cessation, and blood pressure (BP) control) were examined. Performance on quality measures, defined as the percentage of eligible patients receiving recommended care, was examined at the practice level. We used a hierarchical linear model to predict change in practice-level measure performance per quarter, accounting for clustering by practice. We also assessed variations in within-practice performance changes over time by calculating the range for each measure. Results: Data from 150,099 patients from 135 practices was examined. Mean age was 63±14 years, 77% were female, 72% were Caucasian. The most common practice structure was a single-specialty group practice (65%), followed by solo (20%) and multi-specialty group practice (10%). From January 2016 to December 2017 there was an improvement in quarterly performance on disease activity measurement (+2.9%, p<0.001), TB screening (+1.9%, p<0.001), BMI screening in 18-64 years (+2.4%, p<0.001), and tobacco use screening and cessation (+1.2%, p<0.001), and a decline in quarterly performance on BMI screening in >64 years (-0.4%, p<0.001) and BP control (-0.6%, p<0.001). Improvements in performance on RA management measures were steady from Q1 2016 to Q4 2017 (Figure). Within-practice change in performance varied significantly across practices (Table). For example, from 2016 to 2017 within-practice change in performance on blood pressure control varied from a decrease by 66.7% to an increase by 100%. Conclusion: Among practices participating in RISE, from 2016 to 2017 average performance on most measures for individuals with RA improved. We found significant variations in performance over time between practices, suggesting that future work to identify workflow patterns leading to high performance or to dramatic improvements in quality are warranted. Disclaimer: This data was supported by the ACR’s RISE Registry. However, the views expressed represent those of the authors, not necessarily those of the ACR. Quality Measure 2016 2017 Measure denominator (N) Average practice-level performance (%) Measure denominator (N) Average practice-level performance (%) Change in average practice-level performance from 2016 to 2017 (%) Percentile (50th, 99th) Percentile (50th, 99th) Range Disclosure of Interests: Zara Izadi Consultant for: I worked as a paid consultant for Celgene from 2014 to 2017., Gabriela Schmajuk Grant/research support from: Investigator initiated award from Pfizer from 2015-2018, unrelated to this work, Julia Kay: None declared, Rachel Myslinski: None declared, Jinoos Yazdany Grant/research support from: Pfizer, Consultant for: AstraZeneca