BOSTON– A bundle of eight measures was effective in improving the quality of rheumatoid arthritis care while reducing costs, Dr. Eric D. Newman reported at the annual meeting of the American College of Rheumatology.
At the start of the program, 22% of roughly 2,400 RA patients had achieved all of the applicable quality measures that were integrated into the program. After 22 months in the program, 40% had met all of the measures.
Dr. Eric Newman
Using routine disease measures, the program was successful for de-escalating use of biologics among the patients. After 1 year, the associated savings came to $720,000; a savings estimate of $1.2 million is projected for 2014.
“We recognized the importance of objectively and routinely measuring disease activity, and using that information to engage our patients and drive a new systematic strategic approach to rheumatoid arthritis care,” said Dr. Newman, director of rheumatology for the Geisinger Health System, Wilkes-Barre, Penn., and the program’s designer.
The AIM FARTHER (Attribution, Integration, Measurement, Finances and Reporting of Therapies) model was designed and implemented for about 2,400 RA patients cared for by the 17 rheumatologists within the Geisinger Health System. The eight measures included disease activity measures (RA on DMARD, active RA on DMARD, RA with CDAI [Clinical Disease Activity Index], and RA at low disease activity); drug safety measures (TB testing if on a biologic agent, yearly influenza vaccination, and pneumococcal vaccination), and a comorbidity measure (check of LDL cholesterol).
Individual patient scorecards were developed via patient responses on a touch-screen questionnaire and input from physicians, nurses, and the electronic health record. The data were used to measure RA patient care gaps to be resolved. The measures were shared and analyzed to close care gaps as well as create provider and department performance reports.
Before the start of the program, measures were high for the percentage of RA patients and the percentage of patients with active RA on a DMARD as well as the percentage of patients who had their LDLs checked. As a result, only modest further improvements were seen after 22 months of the program (from 88% at baseline to 90% for the percentage of RA patients on a DMARD, from 92% to 93% for RA patients with active disease on a DMARD, and from 93% to 95 for LDL checks).
Significant improvements in other measures were seen, however, including a rise in the use of CDAI measures from 52% to 84%, a rise in TB testing for those on a biologic from 83% to 93%, an increase in yearly influenza vaccination from 59% to 75%, and a rise in pneumococcal vaccination from 59% to 72%.
As a care model, AIM FARTHER seeks to employ provider engagement, process redesign, measurement, and information technology, Dr. Newman said. The components of the program include establishing a registry, defining roles and attribution, integrating primary and specialty care, defining a strategic approach to RA care, developing an RA quality measure bundle, task management and performance reporting, and a financial incentive model.
The success of AIM FARTHER “is not due to any one individual, but [relies on] meaningful involvement of all members of the rheumatology team, holding ourselves accountable, dedicating the time needed to perform the work, and creating an internal forum to discuss quality improvement on a regular basis. This approach moved our rheumatology team from engagement to buy-in to ownership. The result is an RA population management program that is sustainable yet evolving, as we challenge ourselves to continuously improve the quality of care for our patients with rheumatic disease,” Dr. Newman said.
The authors had no disclosures. The work was internally funded by the Geisinger Health System.