Patient Engagement Improving Outcomes for Patients with Rheumatoid Arthritis
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1 Patient Engagement Improving Outcomes for Patients with Rheumatoid Arthritis Ryan Antolini, M.D. Timothy Gensler, M.D. John Janas, M.D.
2 Presenters Denver Arthritis Clinic Ryan Antolini, M.D. Board Certified Internal Medicine, 2005 Rheumatology, 2008 West Virginia University School of Medicine, Morgantown, WV, 2002 Massachusetts General Hospital, Harvard Medical School, Boston, MA, 2008 Timothy Gensler, M.D Board Certified Rheumatology Vanderbilt School of Medicine, Nashville, TN, 1993 Brigham and Women s Hospital, Harvard Medical School, Boston, MA, 1999 Clinical Content Consultants John Janas, M.D. Board Certified Internal Medicine and Pediatrics 1987 Creighton University School of Medicine, Omaha, NE, 1983 Baystate Medical Center, Springfield, MA 1987 President/CEO of Clinical Content Consultants (CCC) Founder Clinical Quality Improvement Collaborative (CQIC)
3 Presentation Description Rheumatoid Arthritis (RA) is a chronic inflammatory disorder affecting millions of Americans. Major advances in the management and treatment of RA have occurred in recent years with the introduction of biologic disease-modifying anti-rheumatic drugs (DMARDs). In 2012, the American College of Rheumatology updated RA medical management guidelines. These guidelines describe which biologic DMARDs to use for specific RA disease profiles (e.g., features such as disease activity, signs and symptoms, and prognosis). Learn how Denver Arthritis Clinic has implemented the use of Rheumatoid Arthritis Disease Activity Surveys to rapidly assess, manage, and track clinical outcomes and responses to treatment.
4 Objective 1 Be able to rapidly administer, document, and calculate the following Rheumatoid Arthritis Disease Activity Surveys RAPID-3 Tool for : the three (3) components required are the Multi-Dimensional Health Assessment Questionnaire (MDHAQ Function Index), Patient Pain Assessment, and Patient Global Severity Scale PAS-II: the three (3) components required are the Health Assessment Questionnaire-II (HAQ-II), Patient Pain Assessment, and Patient Global Severity Scale CDAI: the four (4) components required are the Physician Global Assessment, Patient Global Severity Scale, Total Painful Joints, and Total Swollen Joints
5 Objective 2 Learn how to use Centricity EHR Entry Form Templates for a variety of Patient Assessment Questionnaires that can be used for a variety of clinical quality measures.
6 Objective 3 Learn proven workflows to efficiently administer Patient Assessment Questionnaires and document within the Centricity EHR
7 RAPID-3 (3) components required are: Multi-Dimensional Health Assessment Questionnaire (MDHAQ Function Index) Patient Pain Assessment Patient Global Severity Scale
8 RAPID-3
9 RAPID-3
10 EXAMPLE RAPID-3
11 SCORING RAPID-3
12 INTERPRETING RAPID-3 Near Remission: Moderate: Low: High:
13 EXAMPLE RAPID-3 Moderate
14 PAS-II (3) components required are: Health Assessment Questionnaire-II (HAQ-II) Patient Pain Assessment Patient Global Severity Scale
15 PATIENT COMPLETES
16 PATIENT COMPLETES
17 PATIENT COMPLETES
18 PATIENT COMPLETES
19 SCORING PAS-II
20 INTERPRETING PAS-II Remission: Moderate: Low: High:
21 CDAI (4) components required are: Physician Global Assessment Patient Global Severity Scale Total Painful Joints Total Swollen Joints
22
23 Patient Completes
24 Patient Completes
25
26 SCORING CDAI
27 Scoring/Interpreting CDAI
28 INTERPRETING CDAI Remission: Moderate: Low: High:
29 Objective 1 Rapidly administer, document, and calculate the following Rheumatoid Arthritis Disease Activity Surveys RAPID-3 PAS-II CDAI
30 CQIC Rheumatoid Arthritis Disease Activity Surveys Project Create Entry Form Templates Manual Administration Workflow Print -> Complete -> Staff Enters -> Score (functions-fx) Patient Entered History Send -> Patient Completes -> Retrieve -> Score (FX)
31 CQIC Rheumatoid Arthritis Disease Activity Surveys Project Create Scoring Functions MDHAQ Function Index RAPID-3 / RAPID 4 PAS-II CDAI / CDAI Interpretation
32 CQIC Rheumatoid Arthritis Disease Activity Surveys Project Integrate Musculoskeletal Exam-CCC Enhanced Scoring Tab MDHAQ Function Index RAPID-3 / RAPID 4 CDAI / CDAI Interpretation
33 Rheumatoid Arthritis Disease Activity Survey Entry Form ENTRY Wide View Page 1a MDHAQ
34 Rheumatoid Arthritis Disease Activity Survey Entry Form ENTRY Wide View Page 1a MDHAQ Print Complete Manually Enter Calculate
35 Rheumatoid Arthritis Disease Activity Survey Entry Form ENTRY Wide View Page 1a MDHAQ Print Complete Manually Enter Calculate MDHAQ Score Calculated
36 Rheumatoid Arthritis Disease Activity Survey Entry Form ENTRY Wide View Page 1b HAQ-II
37 Rheumatoid Arthritis Disease Activity Survey Entry Form ENTRY Wide View Page 1b HAQ-II Print Complete Manually Enter Calculate
38 Rheumatoid Arthritis Disease Activity Survey Entry Form ENTRY Wide View Page 1b HAQ-II Print Complete Manually Enter Calculate HAQ-II Score Calculated
39 Rheumatoid Arthritis Disease Activity Survey Entry Form ENTRY Wide View Page 2a Patient Joint Count
40 Rheumatoid Arthritis Disease Activity Survey Entry Form ENTRY Wide View Page 2a Patient Joint Count Print Complete Manually Enter
41 Rheumatoid Arthritis Disease Activity Survey Entry Form ENTRY Wide View Page 2a Patient Joint Count Print Complete Manually Enter Calculate
42 Rheumatoid Arthritis Disease Activity Survey Entry Form ENTRY Wide View Page 3 Patient Pain Score Page 4 Patient Global Score
43 Rheumatoid Arthritis Disease Activity Survey Entry Form Page 3 Patient Pain Score 6.5 Page 4 Patient Global Score 8.0 Print Complete Manually Enter
44 Rheumatoid Arthritis Disease Activity Survey Entry Form Page 3 Calculate RAS Scores PAS-II CDAI RAPID-3 RAPID-4
45 Rheumatoid Arthritis Disease Activity Survey Entry Form Page 3 Calculate RAS Scores PAS-II CDAI RAPID-3 RAPID-4
46 Rheumatoid Arthritis Disease Activity Survey Entry Form NOTE: If try and CALCULATE without completing all fields, get ERROR Message detailing fields are EMPTY!
47 Rheumatoid Arthritis Disease Activity Survey Entry Form EXAMPLE: CDAI requires Physician Global Assessment & Provider JT Count Can Enter EITHER using the Musculoskelet al Exam-CCC Form Scoring Tab
48 Rheumatoid Arthritis Disease Activity Survey Entry Form EXAMPLE: CDAI requires Physician Global Assessment OR ADD fields to the Rheumatoid Arthritis Disease Activity Survey Entry Form
49 Rheumatoid Arthritis Disease Activity Survey Entry Form NOTE: Obs Terms MUST match in the Musculoskelet al Exam-CCC Form Scoring Tab and the ADDED fields to the Rheumatoid Arthritis Disease Activity Survey Entry Form OBSERVATIONS: SWELLJTTOTAL: 8 PAINJTTOTAL: 6 PGAMUSCEXAM: 5.0
50 Rheumatoid Arthritis Disease Activity Survey Entry Form CALCULATE using CQIC Functions for RAS Scoring PROVIDER can then ENTER Interpretation (OPTIONAL)
51 Rheumatoid Arthritis Disease Activity Survey Entry Form CALCULATE using CQIC Functions for RAS Scoring PROVIDER can then ENTER Interpretation (OPTIONAL)
52 INTERPRETING PAS-II Remission: Low: Moderate: High:
53 INTERPRETING CDAI Remission: Low: Moderate: High:
54 INTERPRETING RAPID-3 Near Remission: Low: Moderate: High:
55 Rheumatoid Arthritis Disease Activity Survey Entry Form Can also create a function to auto populate the Interpretation fields Require Provider Verification!!!
56 TEXT TRANSLATION
57 TEXT TRANSLATION
58 Musculoskeletal Exam-CCC Form SCORING TAB OBS TERMS SAME AS Rheumatoid Arthritis Disease Activity Survey ENTRY FORM Calculate BUTTONS
59 Objective 2 Learn how to use Centricity EHR Entry Form Templates for a variety of Patient Assessment Questionnaires that can be used for a variety of clinical quality measures.
60 Objective 3 Learn proven workflows to efficiently administer Patient Assessment Questionnaires and document within the Centricity EHR
61 CQIC Rheumatoid Arthritis Disease Activity Surveys Project Manual Administration Workflow Print -> Complete -> Staff Enters -> Score (Scoring Functions-FX) Patient Entered History Send -> Patient Completes -> Retrieve -> Score (Scoring Functions-FX)
62 Patient Entered History Entry Form Templates can be sent using SECURE MESSAGING for Patient to Complete: TEXT KIOSK MODE
63 Patient Entered History FASTER - SAVES TIME CONVENIENT - EASIER IMPROVES DATA CAPTURE
64 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx SECURE MESSAGE TEXT OR CLICK LINK TO OPEN
65 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx SECURE MESSAGE TEXT OR CLICK TO COMPLETE
66 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS MDHAQ PATIENT ANSWERS QUESTIONS
67 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS MDHAQ PATIENT ANSWERS QUESTIONS
68 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS MDHAQ PATIENT ANSWERS QUESTIONS
69 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS MDHAQ PATIENT ANSWERS QUESTIONS
70 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS HAQ-II PATIENT ANSWERS QUESTIONS
71 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS HAQ-II PATIENT ANSWERS QUESTIONS
72 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS HAQ-II PATIENT ANSWERS QUESTIONS
73 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS PATIENT JOINT SCORE PATIENT ANSWERS QUESTIONS
74 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS PATIENT JOINT SCORE PATIENT ANSWERS QUESTIONS
75 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS PATIENT JOINT SCORE PATIENT ANSWERS QUESTIONS
76 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS PATIENT PAIN SCORE PATIENT ANSWERS QUESTIONS
77 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS PATIENT PAIN SCORE PATIENT ANSWERS QUESTIONS
78 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS PATIENT GLOBAL SCORE PATIENT ANSWERS QUESTIONS
79 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT INSTRUCTIONS PATIENT GLOBAL SCORE PATIENT ANSWERS QUESTIONS
80 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT ANSWERS QUESTIONS CLICKS SUBMIT
81 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT GETS CONFRIMATION OF COMPLETED QUESTIONS (FORM)
82 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT ARRIVES OR BROUGHT INTO EXAM ROOM PROMPT TO RETRIEVE
83 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx CAN ALSO RETRIEVE DIRECTLY FROM ENTRY FORM EXAMPLE ENTRY FORM NOT WIDE VIEW!
84 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT RESPONSES RETRIEVED POPULATES ENTRY FORM MDHAQ HAQ-II
85 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT RESPONSES RETRIEVED POPULATES ENTRY FORM PATIENT JOINT COUNT
86 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT RESPONSES RETRIEVED POPULATES ENTRY FORM PATIENT PAIN SCORE & GLOBAL SCORE
87 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT RESPONSES RETRIEVED POPULATES ENTRY FORM CALCULATE MDHAQ HAQ-II
88 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT RESPONSES RETRIEVED POPULATES ENTRY FORM CALCULATE PATIENT JOINT COUNT
89 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT RESPONSES RETRIEVED POPULATES ENTRY FORM CALCULATE RAS SCORES
90 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT RESPONSES RETRIEVED POPULATES ENTRY FORM TEXT TRANSLATION
91 Rheumatoid Arthritis Disease Activity Survey Patient Entered Hx PATIENT RESPONSES RETRIEVED POPULATES ENTRY FORM TEXT TRANSLATION
92 SCORING OBS TERMS PGAMUSCEXAM: 7.0 MDHAQSCORE: 7 PGS-RHEUM: 8.0 PAINSCRRHEUM: 7.0 RAPID3: 22 HAQIISCORE: 1.90 PGS-RHEUM: 8.0 PAINSCRRHEUM: 7.0 PASIISCORE: 7.11 RADAIPTJTCT: 17 RAPID4 SCORE: 39 PGS-RHEUM: 8.0 SWELLJTTOTAL: 12 PAINJTTOTAL: 10 CDAI: 37
93 HAQ-II OBS TERMS HAQIIQ10: 2: with much difficulty HAQIIQ9: 2: with much difficulty HAQIIQ8: 3: unable to do HAQIIQ7: 2: with much difficulty HAQIIQ6: 2: with much difficulty HAQIIQ5: 1: with some difficulty HAQIIQ4: 2: with much difficulty HAQIIQ3: 2: with much difficulty HAQIIQ2: 2: with much difficulty HAQIIQ1: 1: with some difficulty
94 MDHAQ OBS TERMS MDHAQ1M: 3.3: UNABLE to do MDHAQ1L: 2.2: with MUCH difficulty MDHAQ1K: 1.1: with SOME difficulty MDHAQ1J: 3: UNABLE to do MDHAQ1I: 3: UNABLE to do MDHAQ1H: 2: with MUCH difficulty MDHAQ1G: 2: with MUCH difficulty MDHAQ1F: 2: with MUCH difficulty MDHAQ1E: 2: with MUCH difficulty MDHAQ1D: 2: with MUCH difficulty MDHAQ1C: 2: with MUCH difficulty MDHAQ1B: 2: with MUCH difficulty MDHAQ1A: 1: with SOME difficulty
95 PT JOINT SCORE OBS TERMS RADAIPTJT18: 0: none RADAIPTJT17: 0: none RADAIPTJT16: 0: none RADAIPTJT15: 0: none RADAIPTJT14: 2: moderate RADAIPTJT13: 1: mild RADAIPTJT12: 3: severe RADAIPTJT11: 2: moderate RADAIPTJT10: 0: none RADAIPTJT9: 0: none RADAIPTJT8: 0: none RADAIPTJT7: 0: none RADAIPTJT6: 0: none RADAIPTJT5: 0: none RADAIPTJT4: 2: moderate RADAIPTJT3: 3: severe RADAIPTJT2: 2: moderate RADAIPTJT1: 2: moderate
96 MACRA MIPS PQRS APM Composite Performance Score ACI 25% CPIA 15% Quality QPC 50% RU 10% VBM MU ACOs PCMH BPMs
97 Quality Counts for 50% of Score MIPS Score (year 1): 1. Quality-of-care component 50% 2. Advancing care information accounting 25% 3. Clinical practice improvement 15% 4. Cost 10%
98 MIPS Composite Performance Score (CPS) and Categories Quality Performance Category: replaces PQRS and the quality component of the Value Modifier Program 50 percent of CPS in year 1 Physicians choose 6 measures Additional population measures are calculated based on claims data, with number of measures dependent on group size > 200 measures from which to choose; 80% geared to specialists Quality QPC 50%
99 CQIC CQM Planning Guide
100 TABLE E: 2017 Proposed MIPS Specialty Measure Sets
101 TABLE E: 2017 Proposed MIPS Specialty Measure Sets
102 Q&A Questions? Comments?
103 Contact Information John Janas MD Ryan Antolini MD Timothy Gensler MD
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