Rheumatoid Arthritis Learning Collaborative Sponsored by AMGF and AbbVie
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1 1 Rheumatid Arthritis Learning Cllabrative Spnsred by AMGF and AbbVie August 12-14, 2015 Ochsner Medical Center Best Practices in Managing patients with Rheumatid Arthritis
2 2 Medical Grup Prfile When was yur grup established 1946 # f sites/clinics 4 Rheumatlgy sites Ochnser main campus, Cvingtn, Batn Ruge, Slidell # physicians, rheumatlgist (7.4 FTE (3 at site 1 and 4.4 at 2 nd site, 3 Rheumatlgy NP s) # specialties 80 # patients (average # rheumatlgy annual utpatient visits) 2012: 10,986 Visits 2013: 10,553 visits 2014: 8,892 visits (annualized) D yu currently have an EMR, if s what are yu using? EPIC
3 3 Team Cmpsitin 1. Rbert Quinet MD 2. William Davis MD 3. Arif Shahzad MD 4. Timthy Hilbun (EPIC) 5. Brenda Salmern NP 6. Dr. Karen Tribi, MD 7. Lindsey Huser (EPIC) 8. Judd Pattersn (OT) 9. Tamara Fryer (PT) 10. Debbie Rss (Dietician) 11. Vanessa Jacksn RN 12. Megan Mckenzie
4 4 RA Gals & Objectives Evaluate the use f DMARDS in ur RA ppulatin Develp an actin plan and implement a department wide dcumentatin f RA disease activity at each patient encunter. RAPID 3, DAS28, r CDAI Imprve dcumentatin f functinal status (MDHAQ) Evaluate the use f bilgic rder set which include pre-dmard labs and vaccinatin checks. Imprve utility and safety f EMR by displaying facility administered therapies in utpatient medicatin list.
5 DMARD Use BASELINE (7/1/13 6/30/14) 90% (538/595) 1 ST QUARTER (7/1/14 9/30/14) 84% (368/439) 2 ND QUARTER (10/1/14 12/31/14) 86% (422/491) 3 RD QUARTER (1/1/15 3/31/15) 86% (429/501) 4 TH QUARTER (4/1/15 6/30/15) 95% (362/381) Rlling 12 mnth (7/1/13 6/30/15) 92% (726/788)
6 6 RA RAPID3 DAS28 CDAI BASELINE (7/1/13 6/30/14) 35% (219/595) 1 st QUARTER (7/1/14 9/30/14) 70% (307/439) 2 nd QUARTER (10/1/14 12/31/14) 89% (436/491) 3rd QUARTER (1/1/15 3/31/15) 87% (433/501) 4 TH QUARTER (4/1/15 6/30/15) 92% (351/381) Rlling 12 mnth (7/1/13 6/30/15) 96% (756/788)
7 7 HAQ scres BASELINE (7/1/13 6/30/14) 45% (270/595) 1ST QUARTER (7/1/14 9/30/14) 68% (297/439) 2ND QUARTER (10/1/14 12/31/14) 87% (427/491) 3RD QUARTER (1/1/15 3/31/15) 86% (433/501) 4 TH QUARTER (4/1/15 6/30/15) 91% (347/381) Rlling 12 mnth (7/1/13 6/30/15) 95% (750/788)
8 8 Mean DAS28 Mean CDAI Mean Rapid3 Mean HAQ BASELINE (7/1/13 6/30/14) st QUARTER (7/1/14 9/30/14) nd QUARTER (10/1/14 12/31/14) rd QUARTER (1/1/15 3/31/15) th QUARTER (4/1/15 6/30/15) Rlling 12 mnth (7/1/13 6/30/ Mean DAS28 Scre (remissin <2.6, lw , md , high >5.1) Mean CDAI Scre (remissin <2.8, lw , md 10-22, high >22) Mean Rapid3 Scre (remissin <1, lw 1-2, md 2-4, high >4)
9 9 Accmplishments Increasing dcumentatin f HAQ and disease activity measures in each quarter.
10 Assessments Tab in EPIC 10
11 11 RA screening questinnaire Paul Emery screening questinnaire fr early RA patients Overwhelmed by cmpeting disease screens Sme PCP interest but as a grup, they felt cmfrtable suspecting RA Wuld utilize the RA rder set t facilitate early referral.
12 Created an rder set in EPIC fr Early nset RA Order set fr PCP and referring prviders 2 week pririty appintment
13 13
14 14 Early Arthritis Clinic Staffed by Dr. Tribi (rheumatlgy staff), rheumatlgy NP, 2 nd year fellw t see Fast Track patients n Thursday AM. Musculskeletal Ultrasund availability
15 Early nset RA Order set Educatin was attempted unsuccessfully Primary care was re-educated by their EPIC supprt persn. Dr. Tribi will als emphasize t primary care prviders using early RA rder set generates pririty clinic appintment. Order set prmpted with: Rheumatid, Early Rheum, Early
16 All Rheumatlgist rdering DMARD s r bilgic therapy have fllwing rder set Facilitate rdering essential labs and vaccinatin review and administratin Fast Track t ID r Rheum NP 16
17 17 Future Gal Shared Medical Appintments (SMA) will be after establishing RA diagnsis EULAR patient centered RA evaluatin Patient evaluatin f RA knwledge befre and after each mdule Appt 1.5 hurs, ~10 patients
18 18 RA Shared Medical Appintment Mdule 1 - Intrductin t RA Mdule 2 - Nutritin and Alternative Mdalities -Dietician t present fds with anti-inflammmatry prperties Mdule 3- Activity & RA- -Physical therapist & Occupatinal Therapist -Exhibit assistive devices fr ADLS & splints if needed Mdule 4- RA & Medicatin- -Pharmacist present RA drugs -RN will discuss living n immunsuppressant therapy- educatin- lifestyle, preventing infectins, etc
19 19 Standardizatin f PT and OT RA services Identified dedicated PT, OT, Dietician and pharmacists Mdified PT and OT rders PT and OT will participate in grup educatinal visits
20 Future Steps Wrking n establishing RA registry in EPIC Shared Medical appintments Early RA clinic Analyze HAQ scre t ptimize utilizatin f PT/OT t imprve functin as well as adjustment f pharmaclgic therapy. Analyzing disease activity scres t imprve achievement in remissin and lw disease activity as part f treat t target. Cntinue t ptimize rder set.
21 Thank Yu
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