Poster Presented at the 2014 American College of Rheumatology Annual Meeting

Transcription

1 Poster Presented at the 2014 American College of Rheumatology Annual Meeting Anne Winkler 1 James Mossell 2 Edmund MacLaughlin 3 Drew Johnson 4 J. Timothy Harrington 5 1 Winkler Medical Practice LLC, Springfield, MO 2 Arthritis & Osteo Center of South GA, Tifton, GA 3 Edmund L MacLaughlin LLC, Cambridge, MD 4 Crescendo Bioscience, South San Francisco, CA 5 Joiner Associates LLC, Madison, WI 2015 Joiner Associates LLC 1

2 Background/Purpose Population management (PM) is required for reducing the burdens of chronic diseases, including RA. PM depends on standardizing disease activity assessment (DAA) and coordinating care for the entire disease population, as well as for individuals within this context. Our purpose is to implement PM for RA within rheumatology practices by optimizing DAA to define controlled, low, moderate, and high disease activity cohorts; to focus resources on those patients with the highest needs; and to document our delivery of care and outcomes. Methods The Rheumatoid Arthritis Practice Performance (RAPP) Project is a voluntary collaboration of U.S. clinician rheumatologists whose goal is to improve RA management and to document our performance. Most invited to participate are multi-biomarker disease activity test users. To date, 97 physicians from 91 practices have attended quality improvement project kick-off meetings and each has completed a baseline survey regarding DAA and PM processes. Their aggregated responses are reported here. Results Participants represent all regions of the United States and differing practice environments: solo (33), single specialty (35), and multi-specialty group/integrated system practices (20). RA patients managed per rheumatologist derived from practice billing systems varies from 112 to 1800, self-reported patient visits/day from 12 to 80, and new patients/week from 0 to 32. Forty-six % have mid-level providers sharing in RA management, 91% have an electronic medical record (38 different brands), and 35% have RA disease registry capability. DAAs used are highly variable and often multiple. Composite DAA use varies from none (25%), to RAPID3 (39%), DAS28 (18%), CDAI (20%), and SDAI (2%). Disease activity documentation in medical records includes a non-numeric impression (active/controlled) (63%), 0-10 Physician Global (23%), composite score (11%), or other (3%). Conclusion 1. Practices vary in RA population size, office workflows, staffing, and DAAs utilized. 2. Use of composite disease activity measure is limited with the majority documenting a binary, active/controlled clinical impression. 3. PM processes (analytic disease registries and team management) are used infrequently. 4. These results indicate opportunities to improve practice performance and RA disease outcomes in rheumatology practices Joiner Associates LLC 2

3 To understand the disease activity measures and clinical processes being used by clinician rheumatologists prior to their beginning an RA quality improvement collaborative, the Rheumatoid Arthritis Practice Performance (RAPP) Project. Question 1: What is the total number of RA patients you manage? The RAPP Project currently includes 175 rheumatologists from 148 practices managing over 75,000 RA patients. A 12-question baseline web survey was completed by participants prior to their attending a kick-off project advisory board meeting between April 2013 and September Question 2: Identify the clinical data you routinely collect and use to inform your impression of each patient s RA disease activity. Individual responses from 130 respondents were aggregated for this abstract Joiner Associates LLC 3

4 Question 3: How do you document your global assessment of disease activity (Physician Global)? Question 5: How many patient visits do you typically bill per full office day (all patients)? Question 4: What composite disease activity score do you document routinely, if any? Question 6: How many total new patients/consultations do you see per week? 2015 Joiner Associates LLC 4

5 Question 7: Does your practice employ mid-level providers (physician assistants and/or nurse practitioners)? Question 9: Does your office have Electronic Medical Records (EMR)? Question 8: Do your mid-levels share management of RA patients with the rheumatologists? Question 10: What brand of EMR does your office use? 2015 Joiner Associates LLC 5

6 Question 11: Do you have a practice-based database of your RA patients? Question 12: If yes to Question 11, does your database include clinical disease activity data and/or dates of services as a practice management tool? 1. Practices vary in their RA population size, office workflows, staffing, disease activity data, and measures reported. 2. Use of composite disease activity measures is limited with the majority documenting a binary active-versus-controlled impression. 3. Population processes (analytic disease registries, standardized assessment algorithms, and team management) are used infrequently. 4. These results indicate multiple opportunities to improve practice performance and RA disease outcomes. Disclosures A. Winkler, Novartis Pharmaceutical Corporation 2, Janssen Pharmaceutica Product L.P. 2, Pfizer Inc. 2, Janssen Pharmaceutica Product L.P. 8, Crescendo Bioscience 8, Abbott Immunology Pharmaceuticals 8, Genentech and Biogen IDEC Inc. 8, Bristol-Meyers Squibb 8, Glaxo Smith Klein 8, Pfizer Inc. 8, Crescendo Bioscience 5 J. Mossell, Crescendo Bioscience 5, Genentech and Biogen IDEC Inc. 8, Amgen 8, Abbvie 8, Iroko 8, Takeda 8, Crescendo Bioscience 8, Pfizer 8 E. MacLaughlin, Crescendo Bioscience 5 D. Johnson, Crescendo Bioscience 3 J.T. Harrington, Joiner Associates LLC 5, Crescendo Bioscience 5, Pfizer 5 3 Employment (full or part time); 5 Consulting fees or other remuneration (payment); 8 Speaker's bureau 2015 Joiner Associates LLC 6