OP0316 COST EFFECTIVE INTERVENTION TO IMPROVE QUALITY OF CARE MEASURES FOR RHEUMATOID ARTHRITIS PATIENTS IN AN UNDERSERVED COMMUNITY
Authors: Yvan Maque-Acosta, Julianna Hirsch, Qingying Lai, Rachel Kapelow, Beverly Johnson
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Quality of care measures for rheumatoid arthritis (RA) have been endorsed by the American College of Rheumatology and the CDC. Similar quality indicators have been studied and recommended by the European League Against Rheumatism. Improving quality metrics in an underserved community is a problem given the lack of resources. <h3>Objectives</h3> To identify quality metrics for RA patients with need for improvement in our underserved urban public hospital, and to establish an effective intervention. <h3>Methods</h3> An initial retrospective chart review established baseline data from patients with RA seen in our clinic (July 2015 - July 2016), they were identified by ICD-9/10 coding. We identified 3 RA measures needing improvement: (a) tuberculosis screening (TBsc) 12 months prior to starting a new biologic agent, b) documentation of clinical disease activity index (CDAI) in &gt;/=50% of encounters, c) appropriate pneumococcal vaccination. We then planned an intervention by placing index cards at computer stations to remind providers to check these measures. We collected data on these 3 variables prior to the intervention (December 2016 - July 2017) and 30+ days after (August 2017 - December 2017). We also compared these results by provider type (attendings and fellows). For statistical analysis we used Chi-Square test and SPSS 24. <h3>Results</h3> Baseline data included 240 patients, analysis prior to the intervention included 86 patients, and after the intervention included 131 patients. CDAI documentation was improved from 72.1% to 86.3% (Figure 1, p=0.01), however when stratifying the analysis by provider type, this improvement was only significant in attendings (p=0.005) and not in fellows (p=0.43). Further analysis by including only the same fellows in both pre and post intervention moments (some fellows graduated) showed a significant difference in both groups (attendings: p=0.005; fellows: p=0.024). In terms of TBsc, baseline data showed 73.1% compliance, however we already found a compliance of 100% prior to the intervention (Figure 2, p=0.002 when compared with baseline data). Finally, there was no difference in compliance with pneumococcal vaccination between baseline data, prior and post intervention (p=0.895). <h3>Conclusion</h3> Placing a card reminding providers to check 3 RA quality measures significantly improved CDAI documentation after 30 days of starting the intervention. The compliance with TBsc prior to starting a new biologic agent was 100% even before the intervention, which was better compared to baseline data, likely due to providers being aware there was a problem after initial data was collected. We did not find improvement in pneumococcal immunization rate, most likely because there are multifactorial components to motivating patients to get the vaccine. Our results suggest that interventions as simple as raising provider awareness to a problem such as TB screening, and an index card to remind people to document CDAI can be effective to improve QI measures in RA patients in underserved communities. <h3>References</h3> [1] Yazdany K, et al. Development of the American College of Rheumatology's RA Electronic Clinical Quality Measures. Arthritis Care &amp; Research. 2016; 68 (11): 1579–1590. [2] Petersson I, et al. Development of healthcare quality indicators for RA in Europe. Ann. Rheum. Dis. 2014;73(5):906-8. [3] Lai Q, Johnson B. Improving Quality of Care for RA Patients in an Underserved Area. Arthritis Rheumatol. 2017; 69 (suppl 10). <h3>Disclosure of Interests</h3> None declared