Measuring Quality of Care in People with Arthritis Sarah Sampsel, MPH

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Measuring Quality of
Care in People with
Arthritis
Sarah Sampsel, MPH
National Committee for Quality
Assurance
©2004 by the National Committee for
Quality Assurance
AcademyHealth 2004
Introduction
• Arthritis and other rheumatic conditions
– Leading cause of disability among adults in the
United States
– Early intervention could reduce chronic
symptoms
– Highest utilizers of NSAIDs
– Often receive suboptimal care to treat
symptoms
– Potential for improvement with standardized
measurement
Objectives
• Assess Desirable Attributes (HEDIS® )
(selected)
– Feasibility: barriers to implementation
– Validity: age limits, exclusions, diagnoses
– ‘Actionability’: variation in performance
across plans and geographic regions
Methods
• Multi-disciplinary expert panel
• Volunteer testing by health plans
• Abstraction from administrative and
medical record data
Arthritis Measures
• % of patients screened for pain and functional status
• % with osteoarthritis with recommendations for weight
loss, physical activity, acetaminophen use
• % of high risk patients using non-steroidal antiinflammatory drugs (NSAIDs) and receiving
gastrointestinal prophylaxis
• % of patients with rheumatoid arthritis receiving a
disease modifying anti-rheumatic drug (DMARD)
Principal Findings
Arthritis symptom assessment: documentation of
assessment of pain and functional status
Diagnosis
Arthritis
Prevelance/1000
Pain
Assessment
Functional
Assessment
OA
C = 1.8
M+C = 14.1
Md = 0.2
82.9%
56.1%
RA
C = 1.4
M+C = 7.3
Md = 0.2
77.0%
57.7%
Other
Inflammatory
C = 0.3
M+C = 0.7
Md = 0.0
67.0%
55.3%
C = Commercial; M+C = Medicare + Choice; Md = Medicaid
Principal Findings
Osteoarthritis care: documentation of recommendations for
weight loss and physical activity, acetaminophen use
Plan
Weight
Loss*
Physical
Activity
Acetaminophen
A
33.3%
41.2%
16.7%
A – Medicare
35.0%
22.2%
15.1%
B
57.9%
43.5%
14.0%
OA Prevalence/1000 members: Commercial: 1.2; Medicare + Choice: 78.1
*Credit given for members with BMI < 27 kg/m2 and no
recommendation for weight loss or those with BMI > 27 kg/m2 and a
documented recommendation for weight loss
Principal Findings
Appropriate gastrointestinal prophylaxis for high risk
patients utilizing prescription NSAIDs
Plan
% Adult Members
with NSAID Rx
11.9%
% high risk patients
with GI prophylaxis
22.6%
A – M+C
26.0%
14.3%
B
12.2%
34.2%
C
13.5%
40.8%
C – Md
5.3%
35.3%
A
C = Commercial; M+C = Medicare + Choice; Md = Medicaid
Principal Findings
Disease Modifying Anti-Rheumatic Drug (DMARD)
Therapy in Rheumatoid Arthritis
Plan RA
Commercial Medicaid Medicare
Prevalence/1000
A
C = 0.8
67.6%
N/A
71.4%
M+C = 5.4
C
C = 2.1
75.8%
76.5%
N/A
Md = 1.1
C = Commercial; M+C = Medicare + Choice; Md = Medicaid
• Only measure with potential for HEDIS inclusion
• Use of Biologic DMARD Therapies <11% of prescriptions
Summary of Findings
• Administrative data unreliable for
identification of osteoarthritis cases
– Expected prevalence: 15 - 20%
– Field-Test: 1% (Comm.), 8% (Medicare + C)
– Potential under-coding and under-reporting
• Enormous potential for improvement
– Documentation of services that were provided
Summary of Findings
• Challenges for measure implementation
– Lack of medical record documentation
– Unable to locate documentation of many
aspects of care measured
– Inconsistency of documentation
– Lack of standardized instruments to assess
pain and functional status
Implications
• Performance measures create a powerful tool
for quality improvement and delivery system
comparisons
• Quality of care improvement in arthritis will
require better coding of diagnosis and
documentation of care rendered
Musculoskeletal Workgroup
• Teresa Brady, PhD
– CDC Arthritis Program
• John Klippel, MD
– Arthritis Foundation
• Catherine MacLean,
MD, PhD
– UCLA/RAND
• John Mason, PhD
– BCBS of Massachusetts
• Kenneth Saag, MD,
MSc
– University of Alabama at
Birmingham, CERTS
• Khaled Saleh, MD,
MSc, FRCSC
– Univ. of Minnesota
• Daniel Solomon, MD,
MPH
– Brigham & Women’s
Hospital
• Jeffrey Susman, MD
– Univ. of Cincinnati
• Patricia Venus
– Center for Health Care
Policy and Evaluation
• Neil Wenger, MD
– UCLA
Supported in part b y: Janssen Pharmaceutica, Merck & Company,
Purdue Pharma, Pfizer Inc., Amgen
Acknowledgements
• Co-Authors:
– Catherine MacLean, MD, PhD; RAND Health and UCLA
Division of Rheumatology
– Philip Renner, MBA; National Committee for Quality Assurance
– Russell Mardon, PhD; National Committee for Quality
Assurance
• Project was a partnership between NCQA and the
Arthritis Foundation, and built upon work conducted by
RAND Health/University of Alabama at Birmingham:
Arthritis Foundation Quality Indicator Project (AFQuIP)
– MacLean CH, et al. Measuring Quality in Arthritis Care: Methods
for Developing the Arthritis Foundation’s Quality Indicator Set.
Arthritis Care & Research. 2004;51(2):193-202.
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