Influence of Continuing Medical Education on Rheumatologists' Performance on National Quality Measures for Rheumatoid Arthritis

Introduction

In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists’ performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-education chart audits.

Methods

Twenty community-based rheumatologists across the United States were recruited to participate in the QI education program and chart audits. Charts were retrospectively audited before (n = 160 charts) and after (n = 160 charts) the rheumatologists participated in a series of accredited QI-focused educational activities that included private audit feedback, small-group webinars, and online- and mobile-accessible print and video activities. The charts were audited for patient demographics and the rheumatologists’ documented performance on the 6 quality measures for RA included in the Physician Quality Reporting System (PQRS). In addition, charts were abstracted for documentation of patient counseling about medication benefits/risks and adherence, lifestyle modifications, and quality of life; assessment of RA medication side effects; and assessment of RA medication adherence.

Results

Mean rates of documented performance on 4 of the 6 PQRS measures for RA were significantly higher in the post-education versus baseline charts (absolute increases ranged from 9 to 24% of patient charts). In addition, after the intervention, significantly higher mean rates were observed for patient counseling about medications and quality of life, and for assessments of medication side effects and adherence (absolute increases ranged from 9 to 40% of patient charts).

Conclusion

This pragmatic study provides preliminary evidence for the positive influence of QI-focused education in helping rheumatologists improve performance on national quality measures for RA.

Electronic supplementary material

The online version of this article (doi:10.1007/s40744-015-0018-7) contains supplementary material, which is available to authorized users.

Implementation and assessment of a fall screening program in primary care practices

Fall prevention strategies for older adults are underused in primary care. A study was designed to examine the Centers for Medicare and Medicaid Services Physician Quality Reporting System (PQRS) fall measures and to reduce injuries and costs from falls by 10%. This quality improvement project using a pre/post design was implemented in four primary care practices with 2,021 patients aged 65 and older in Asheville, North Carolina. The project used a patient registry, electronic templates, standardized care protocols, a falls clinic to evaluate individuals who reported falling, and patient resource materials. Data were collected from medical records on processes of care, fall-related injuries, and anticipated payments. Individuals billed for at least one outpatient visit from July 2011 through June 2012 (n = 2,021) constituted the cohort for the intervention and for analysis of injuries from falls requiring hospital visits (before the intervention (T1): July 2010 to March 2011; after the intervention (T2): July 2012 to March 2013). Practice sites properly screened 68.8% of older adults for falls, assessed 87% of those who reported falling, and documented the PQRS required plan of care in 23%. Only 20% self-reported falls. Numbers of falls requiring a visit to the hospital were small overall and did not decrease (T1, 2.4%; T2, 2.9%; P = .32); 61% of individuals seen in the hospital for fall-related injuries had not reported previous falls. Incorporating the PQRS fall measures into primary care was challenging, and the program was not robust enough to reduce serious falls and hospital costs.

Health information technology: help or hindrance?

The practice of medicine in general and nephrology in particular grows increasingly complex with each passing year. In parallel with this trend, the purchasers of health care are slowly shifting the reimbursement paradigm from one based on rewarding transactions, or work performed, to one that rewards value delivered. Within this context, the health-care value equation is broadly defined as quality divided by costs. Health information technology has been widely recognized as 1 of the foundations for delivering better care at lower costs. As the largest purchaser of health care in the world, the Centers for Medicare and Medicaid Services has deployed a series of interrelated programs designed to spur the adoption and utilization of health information technology. This review examines our known collective experience in the practice of nephrology to date with several of these programs and attempts to answer the following question: Is health information technology helping or hindering the delivery of value to the nation's health-care system? Through this review, it was concluded overall that the effect of health information technology appears positive; however, it cannot be objectively determined because of the infancy of its utilization in the practice of medicine.

Translating improved quality of care into an improved quality of life for patients with inflammatory bowel disease

The term quality of care has been interpreted in different ways in medicine. Skeptics of the quality movement insist that checkboxes and government and payer oversight will not lead to better patient outcomes. Supporters refer to areas in medicine in which quality improvement efforts have led to improved survival, such as in cystic fibrosis and cardiovascular disease. For quality improvement to be effective, the process demands rigorous documentation, analysis, feedback, and behavioral change. This requires valid metrics and mechanisms to provide dynamic point-of-care (or close to point of care) feedback in a manner that drives improvement. For inflammatory bowel disease, work has been performed in Europe and the United States to develop a framework for how practitioners can improve quality of care. Improve Care Now has created a sophisticated quality improvement program for pediatric patients with inflammatory bowel disease. The American Gastroenterology Association has worked within the National Quality Strategy framework to develop quality measures for patients with inflammatory bowel disease that have been incorporated into Federal programs that are moving Medicare reimbursement from a volume-based to a value-based structure. The Crohn's and Colitis Foundation of America is initiating a quality intervention program that can be implemented in community and academic practices to stimulate continual improvement processes for patients with inflammatory bowel disease. All of this work is intended to make quality improvement programs both feasible and useful, with the ultimate goal of improving quality of life for our patients.