Rheumatoid Arthritis Learning Collaborative Sponsored by AMGF and AbbVie

Transcription

1 1 Add your company logo here Rheumatoid Arthritis Learning Collaborative Sponsored by AMGF and AbbVie August 13-15, 2014 AIR at UR Developing Best Practice Guidelines for Management of Rheumatoid Arthritis

2 2 Go to view/master/slide Master and Insert Medical Group Profile Strong Memorial Hospital: established in 1925 Main hospital >800 beds; 1,000+ FTEs; URMC Largest Rheumatology group in Rochester/ Buffalo area # rheumatologist (FTEs) 6.3 # Sites 2; clinics 3.5 clinics/ week # patients: >12,000 patients a year 2,900 RA patients a year (230 new patients; 598 follow up patients) EMR: Currently using Epic (2012); Allscripts 2008

3 3 Team Composition Allen Anandarajah, MD, MSc Bethany Marston, MD Ralf Thiele, MD Linda Grinnel-Merrick, NP Robert Brown (Patient) Terrence Anderson (Patient)

4 4 RA Goals & Objectives Early Arthritis Clinic was established 2005 Early RA clinic and established RA clinic. Goal: Develop state of the art treatment facility for RA Specific objectives Ensure and facilitate early referral Make early diagnosis Start early DMARD therapy Develop ideal outcome measures Ensure patient safety

5 5 RA Goals & Objectives Where are you know? Early referral: established via early RA clinic Internet, local Arthritis Foundation, specific , special phone number, word of mouth Early diagnosis: Use of ultrasound Early treatment/ DAMRD use: established Develop ideal outcome measures Joint counts, DAS 28, CDAI Comparison/ Assess remission with ultrasound Ensure patient safety: Education and documentation - vaccines, PPD, immunization, infections, side effects, comorbidities (osteoporosis, lung disease)

6 6 RA Intervention & Population Baseline Patients are mainly identified mainly from the RA clinics. RA registry was to identify patients - in 2005; since 2008 use of CORRONA; use of EMR in the past 2 years. DMARD use at baseline: 73% No reports on DAS 28, CDAI or SDAI available Buy in from colleagues, PCPs, hospital leadership and pharmaceutical companies. Huge investment in time: additional personal, change in clinic schedules, working overtime. Staff involved in this intervention: Nurse manager, NP Education and Feedback.

7 7 Measures Used National clinical standards used: DAS 28, CDAI, SDAI (based on faculty decision) DMARD use PPD/ TB screening Access for RA; 2-6 weeks Data sources and data collection. Initially done using excel; flowcast Using CORRONA Developing means to use EMR

8 8 Improvement Interventions Use HIT to improve safety measures for patients on biologic therapies Identify/ Develop measures to assess for co-morbidities associated with RA Create dashboard: use for prior authorizations Educational projects for Medical students/ residents/ fellows Thiele RG, Anandarajah AP, Tabechian D. Ultrasonography Shows Persistent Hyperemia of Synovial Tissues in Rheumatoid Arthritis Despite Apparent Serological Remission. Arthritis Rheum 2009; 60 Suppl 10: 1453 Anandarajah AP, Thiele R, Giampoli E, Monu J, Seo G, Feng C, Ritchlin CT. Rheumatoid Arthritis patients in clinical remission manifest persistent joint inflammation on histology and imaging studies. J; Rheumatology 2014; in press

9 9 Challenges or Obstacles Biggest challenges Division/ Department Physician buy in - time being main concern, lack of incentives Department/ Physician community Lack of understanding for the need Referral for other diseases Others Financial Data collection, education Time Personal Nursing help

10 10 Outcomes and Successes Key elements that contributed to the success of initiative? Genuine interest and hard work What are the results? Already discussed

11 11 Future Steps Next steps: Use EMR to develop measures to collect and assess data on a regular basis Develop dashboard What do you hope to achieve? Develop a one page report card that can be used to summarize patient s progress over the years. Develop a standardized protocol for prior authorization for biologic therapies and small molecules. Develop a dashboard / report card that will include standardized protocols for monitoring of patients on biologic therapies - PPD reports, hepatitis panel and immunization records all on one page.

12 12 Lessons Learned Describe your lessons learned. Need for lots of time and commitment Rewards in the form of Patient care Educational tools Aids Research activities

13 13 Questions Do you have any questions you d like to pose to the group? Interested in learning how other have approached the issue