Abstract
BackgroundRoutine collection of disease activity (DA) and patient-reported outcomes (PROs) in rheumatoid arthritis (RA) are nationally endorsed quality measures and critical components of a treat-to-target approach. However, little is known about the role electronic health record (EHR) systems play in facilitating performance on these measures.ObjectiveUsing the American College Rheumatology’s (ACR’s) RISE registry, we analyzed the relationship between EHR system and performance on DA and functional status (FS) quality measures.MethodsWe analyzed data collected in 2018 from practices enrolled in RISE. We assessed practice-level performance on quality measures that require DA and FS documentation. Multivariable linear regression and zero-inflated negative binomial models were used to examine the independent effect of EHR system on practice-level quality measure performance, adjusting for practice characteristics and patient case-mix.ResultsIn total, 220 included practices cared for 314,793 patients with RA. NextGen was the most commonly used EHR system (34.1%). We found wide variation in performance on DA and FS quality measures by EHR system (median 30.1, IQR 0-74.8, and median 9.0, IQR 0-74.2), respectively). Even after adjustment, NextGen practices performed significantly better than Allscripts on the DA measure (51.4% vs 5.0%; P<.05) and significantly better than eClinicalWorks and eMDs on the FS measure (49.3% vs 29.0% and 10.9%; P<.05).ConclusionsPerformance on national RA quality measures was associated with the EHR system, even after adjusting for practice and patient characteristics. These findings suggest that future efforts to improve quality of care in RA should focus not only on provider performance reporting but also on developing and implementing rheumatology-specific standards across EHRs.
Highlights
The routine collection of disease activity (DA) and patient-reported outcomes (PROs) such as functional status (FS) in rheumatoid arthritis (RA) are nationally endorsed quality measures and an important component of tracking outcomes and improving care [1,2,3]
Performance on national RA quality measures was associated with the electronic health record (EHR) system, even after adjusting for practice and patient characteristics
Zero-inflated negative binomial models revealed that the differences in performance across EHRs were driven largely by the practices with absent documentation of DA and FS: we found no differences in the count portion of the zero-inflated negative binomial (ZINB) model across EHRs, there were significant differences between NextGen versus other EHRs in the logit portion of the model
Summary
The routine collection of disease activity (DA) and patient-reported outcomes (PROs) such as functional status (FS) in rheumatoid arthritis (RA) are nationally endorsed quality measures and an important component of tracking outcomes and improving care [1,2,3]. The process of collecting these assessments is essential to the implementation of a treat-to-target strategy, which has been shown to improve outcomes for patients with RA and decrease health care utilization [4]. No studies have evaluated the relationship between the EHR system and performance on important quality measures on a national scale across rheumatology practices. Routine collection of disease activity (DA) and patient-reported outcomes (PROs) in rheumatoid arthritis (RA) are nationally endorsed quality measures and critical components of a treat-to-target approach. Little is known about the role electronic health record (EHR) systems play in facilitating performance on these measures
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