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Aboabat A, Ahmad Z, Steiman A, Johnson SR. Quality Measures in Systemic Sclerosis. Diagnostics (Basel) 2023; 13:diagnostics13040579. [PMID: 36832067 PMCID: PMC9955321 DOI: 10.3390/diagnostics13040579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/07/2023] Open
Abstract
Quality improvement is an emerging field, that applies principles of improvement science and utilizes measurement methods with the aim of improving patient care. Systemic sclerosis (SSc) is a systemic autoimmune rheumatic disease associated with increased healthcare burden, cost, morbidity, and mortality. Gaps in delivering care to patients with SSc have been consistently observed. In this article, we introduce the discipline of quality improvement and its use of quality measures. We summarize and comparatively evaluate three sets of quality measures that have been proposed to evaluate the quality of care of patients with SSc. Finally, we highlight the areas of unmet needs and indicate future directions for quality improvement and quality measures in SSc.
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Affiliation(s)
- Aos Aboabat
- Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Zareen Ahmad
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Amanda Steiman
- Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Sindhu R. Johnson
- Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON M5T 1R8, Canada
- Correspondence: ; Tel.: +1-416-603-6417; Fax: +1-416-603-4348
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Donnelly C, Janssen A, Vinod S, Stone E, Harnett P, Shaw T. A Systematic Review of Electronic Medical Record Driven Quality Measurement and Feedback Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010200. [PMID: 36612522 PMCID: PMC9819986 DOI: 10.3390/ijerph20010200] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 06/09/2023]
Abstract
Historically, quality measurement analyses utilize manual chart abstraction from data collected primarily for administrative purposes. These methods are resource-intensive, time-delayed, and often lack clinical relevance. Electronic Medical Records (EMRs) have increased data availability and opportunities for quality measurement. However, little is known about the effectiveness of Measurement Feedback Systems (MFSs) in utilizing EMR data. This study explores the effectiveness and characteristics of EMR-enabled MFSs in tertiary care. The search strategy guided by the PICO Framework was executed in four databases. Two reviewers screened abstracts and manuscripts. Data on effect and intervention characteristics were extracted using a tailored version of the Cochrane EPOC abstraction tool. Due to study heterogeneity, a narrative synthesis was conducted and reported according to PRISMA guidelines. A total of 14 unique MFS studies were extracted and synthesized, of which 12 had positive effects on outcomes. Findings indicate that quality measurement using EMR data is feasible in certain contexts and successful MFSs often incorporated electronic feedback methods, supported by clinical leadership and action planning. EMR-enabled MFSs have the potential to reduce the burden of data collection for quality measurement but further research is needed to evaluate EMR-enabled MFSs to translate and scale findings to broader implementation contexts.
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Affiliation(s)
- Candice Donnelly
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Anna Janssen
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Shalini Vinod
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, University of New South Wales, Liverpool, NSW 2170, Australia
| | - Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
- School of Clinical Medicine, University of New South Wales, Randwick, NSW 2031, Australia
| | - Paul Harnett
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW 2145, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
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Byrd C, Ajawara U, Laundry R, Radin J, Bhandari P, Leung A, Han S, Asch SM, Zeliadt S, Harris AHS, Backhus L. Performance of a rule-based semi-automated method to optimize chart abstraction for surveillance imaging among patients treated for non-small cell lung cancer. BMC Med Inform Decis Mak 2022; 22:148. [PMID: 35659230 PMCID: PMC9166440 DOI: 10.1186/s12911-022-01863-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aim to develop and test performance of a semi-automated method (computerized query combined with manual review) for chart abstraction in the identification and characterization of surveillance radiology imaging for post-treatment non-small cell lung cancer patients.
Methods
A gold standard dataset consisting of 3011 radiology reports from 361 lung cancer patients treated at the Veterans Health Administration from 2008 to 2016 was manually created by an abstractor coding image type, image indication, and image findings. Computerized queries using a text search tool were performed to code reports. The primary endpoint of query performance was evaluated by sensitivity, positive predictive value (PPV), and F1 score. The secondary endpoint of efficiency compared semi-automated abstraction time to manual abstraction time using a separate dataset and the Wilcoxon rank-sum test.
Results
Query for image type demonstrated the highest sensitivity of 85%, PPV 95%, and F1 score 0.90. Query for image indication demonstrated sensitivity 72%, PPV 70%, and F1 score 0.71. The image findings queries ranged from sensitivity 75–85%, PPV 23–25%, and F1 score 0.36–0.37. Semi-automated abstraction with our best performing query (image type) improved abstraction times by 68% per patient compared to manual abstraction alone (from median 21.5 min (interquartile range 16.0) to 6.9 min (interquartile range 9.5), p < 0.005).
Conclusions
Semi-automated abstraction using the best performing query of image type improved abstraction efficiency while preserving data accuracy. The computerized query acts as a pre-processing tool for manual abstraction by restricting effort to relevant images. Determining image indication and findings requires the addition of manual review for a semi-automatic abstraction approach in order to ensure data accuracy.
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Pallua J, Schirmer M. Identification of Five Quality Needs for Rheumatology (Text Analysis and Literature Review). Front Med (Lausanne) 2021; 8:757102. [PMID: 34760902 PMCID: PMC8573257 DOI: 10.3389/fmed.2021.757102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022] Open
Abstract
Background: While the use of the term "quality" in industry relates to the basic idea of making processes measurable and standardizing processes, medicine focuses on achieving health goals that go far beyond the mere implementation of diagnostic and therapeutic processes. However, the quality management systems used are often simple, self-created concepts that concentrate on administrative processes without considering the quality of the results, which is essential for the patient. For several rheumatic diseases, both outcome and treatment goals have been defined. This work summarizes current mainstreams of strategies with published quality efforts in rheumatology. Methods: PubMed, Cochrane Library, and Web of Science were used to search for studies, and additional manual searches were carried out. Screening and content evaluation were carried out using the PRISMA-P 2015 checklist. After duplicate search in the Endnote reference management software (version X9.1), the software Rayyan QCRI (https://rayyan.qcri.org) was applied to check for pre-defined inclusion and exclusion criteria. Abstracts and full texts were screened and rated using Voyant Tools (https://voyant-tools.org/). Key issues were identified using the collocate analysis. Results: The number of selected publications was small but specific (14 relevant correlations with coefficients >0.8). Using trend analysis, 15 publications with relative frequency of keywords >0.0125 were used for content analysis, revealing 5 quality needs. The treat to target (T2T) initiative was identified as fundamental paradigm. Outcome parameters required for T2T also allow quality assessments in routine clinical work. Quality care by multidisciplinary teams also focusing on polypharmacy and other quality aspects become essential, A global software platform to assess quality aspects is missing. Such an approach requires reporting of multiple outcome parameters according to evidence-based clinical guidelines and recommendations for the different rheumatic diseases. All health aspects defined by the WHO (physical, mental, and social health) have to be integrated into the management of rheumatic patients. Conclusion: For the future, quality projects need goals defined by T2T based initiatives in routine clinical work, secondary quality goals include multidisciplinary cooperation and reduction of polypharmacy. Quality indicators and standards in different health systems will provide new information to optimize patients' care in different health systems.
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Affiliation(s)
- Johannes Pallua
- University Hospital for Orthopedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.,Fachhochschule Gesundheit, Health University of Applied Sciences Tyrol, Innsbruck, Austria
| | - Michael Schirmer
- Department of Internal Medicine, University Clinic II, Innsbruck Medical University, Innsbruck, Austria
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Wilson AM, Benish SM, McCarthy L, Romano JG, Lundgren KB, Byrne M, Schierman B, Jones LK. Quality of Neurologic Care in the United States: Initial Report From the Axon Registry. Neurology 2021; 97:e651-e659. [PMID: 34145002 DOI: 10.1212/wnl.0000000000012378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/14/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To provide the initial description of the quality of outpatient US neurologic care as collected and reported in the Axon Registry. METHODS We describe characteristics of registry participants and the performance of neurology providers on 20 of the 2019 Axon Registry quality measures. From the distribution of providers' scores on a quality measure, we calculate the median performance for each quality measure. We test for associations between quality measure performance, provider characteristics, and intrinsic measure parameters. RESULTS There were 948 neurology providers who contributed a total of 6,480 provider-metric observations. Overall, the average quality measure performance score at the provider level was 66 (median 77). At the measure level (n = 20), the average quality measure performance score was 53 (median 55) with a range of 2 to 100 (interquartile range 20-91). Measures with a lower-complexity category (e.g., discrete orders, singular concepts) or developed through the specialty's qualified clinical data registry pathway had higher performance distributions. There was no difference in performance between Merit-Based Incentive Payment System (MIPS) and non-MIPS providers. There was no association between quality measure performance and practice size, measure clinical topic/neurologic condition, or measure year of entry. CONCLUSIONS This cross-sectional assessment of quality measure performance in 2019 Axon Registry data demonstrates modest performance scores and considerable variability across measures and providers. More complex measures were associated with lower performance. These findings serve as a baseline assessment of quality of ambulatory neurologic care in the United States and provide insights into future measure design.
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Affiliation(s)
- Andrew M Wilson
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN.
| | - Sarah M Benish
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Lucas McCarthy
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Jose G Romano
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Karen B Lundgren
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Margaret Byrne
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Becky Schierman
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Lyell K Jones
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
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Solomon DH, Rudin RS. Digital health technologies: opportunities and challenges in rheumatology. Nat Rev Rheumatol 2020; 16:525-535. [PMID: 32709998 DOI: 10.1038/s41584-020-0461-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 12/22/2022]
Abstract
The past decade in rheumatology has seen tremendous innovation in digital health technologies, including the electronic health record, virtual visits, mobile health, wearable technology, digital therapeutics, artificial intelligence and machine learning. The increased availability of these technologies offers opportunities for improving important aspects of rheumatology, including access, outcomes, adherence and research. However, despite its growth in some areas, particularly with non-health-care consumers, digital health technology has not substantially changed the delivery of rheumatology care. This Review discusses key barriers and opportunities to improve application of digital health technologies in rheumatology. Key topics include smart design, voice enablement and the integration of electronic patient-reported outcomes. Smart design involves active engagement with the end users of the technologies, including patients and clinicians through focus groups, user testing sessions and prototype review. Voice enablement using voice assistants could be critical for enabling patients with hand arthritis to effectively use smartphone apps and might facilitate patient engagement with many technologies. Tracking many rheumatic diseases requires frequent monitoring of patient-reported outcomes. Current practice only collects this information sporadically, and rarely between visits. Digital health technology could enable patient-reported outcomes to inform appropriate timing of face-to-face visits and enable improved application of treat-to-target strategies. However, best practice standards for digital health technologies do not yet exist. To achieve the potential of digital health technology in rheumatology, rheumatology professionals will need to be more engaged upstream in the technology design process and provide leadership to effectively incorporate the new tools into clinical care.
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Affiliation(s)
- Daniel H Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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7
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Nurses' Attitudes Toward Electronic Clinical Quality Measures: A Descriptive Study. J Nurs Care Qual 2020; 35:E29-E34. [PMID: 32433155 DOI: 10.1097/ncq.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Electronic clinical quality measures (eCQMs) are a method that automatically extract data from electronic health records (EHRs) and compute and generate the results to report and track the quality of care and patient outcomes. PURPOSE The purpose of this study was to explore nurses' attitudes toward eCQMs and the factors influencing this attitude. METHODS A descriptive cross-sectional study was conducted using a closed-ended questions survey of 92 nurses in a teaching hospital. RESULTS The average score for nurses' attitudes toward eCQMs was 3.47 out of 4. Participants with a master's degree had more positive attitudes than those with a baccalaureate degree. Head nurses had more positive attitudes than staff nurses. CONCLUSIONS The nurses in the study hospital have a positive attitude toward eCQMs. Health care organizations should strengthen the attitudes of nurses toward eCQMs.
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8
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Beketova TV. The development of rheumatology at the stage of formation of a new technological paradigm. RHEUMATOLOGY SCIENCE AND PRACTICE 2019. [DOI: 10.14412/1995-4484-2019-490-495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Cannon GW, Rojas J, Reimold A, Mikuls TR, Bergman D, Sauer BC. Extraction of Rheumatoid Arthritis Disease Activity Measures From Electronic Health Records Using Automated Processing Algorithms. ACR Open Rheumatol 2019; 1:632-639. [PMID: 31872185 PMCID: PMC6917327 DOI: 10.1002/acr2.11089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/06/2019] [Indexed: 11/07/2022] Open
Abstract
Objective The accurate and efficient collection and documentation of disease activity measures (DAMs) is critical to improve clinical care and outcomes research in rheumatoid arthritis (RA). This study evaluated the performance of an automated process to extract DAMs from medical notes in the electronic health record (EHR). Methods An automated text processing system was developed to extract the Disease Activity Score for 28 joints (DAS28) and its clinical and laboratory elements from the Veterans Affairs EHR for patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry. After automated text processing derivation, data accuracy was assessed by comparing the automated text processing system and manual extraction with gold standard chart review in a separate validation phase. Results In the validation phase, 1569 notes from 596 patients at 3 sites were evaluated, with 75 (6%) notes detected only by automated text processing, 85 (5%) detected only by manual extraction, and 1408 (90%) detected by both methods. The accuracy of automated text processing ranged from 90.7% to 96.7% and the accuracy of manual extraction ranged from 91.3% to 95.0% for the different clinical and laboratory elements. The accuracy of the two methods to calculate the DAS28 was 78.1% for automated text processing and 78.3% for manual extraction. Conclusion The automated text processing approach is highly efficient and performed as well as the manual extraction approach. This advance has the potential for significant improvements in the collection, documentation, and extraction of these data to support clinical practice and outcomes research relevant to RA as well as the potential for broader application to other health conditions.
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Affiliation(s)
- Grant W Cannon
- George E. Wahlen Department of Veterans Affairs Salt Lake City Health Care System and University of Utah, Salt Lake City
| | - Jorge Rojas
- George E. Wahlen Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Andreas Reimold
- Dallas Department of Veterans Affairs Medical Center and University of Texas Southwestern, Dallas
| | - Ted R Mikuls
- Department of Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Debra Bergman
- Department of Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Brian C Sauer
- George E. Wahlen Department of Veterans Affairs Salt Lake City Health Care System and University of Utah, Salt Lake City
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Winthrop KL, Weinblatt ME, Bathon J, Burmester GR, Mease PJ, Crofford L, Bykerk V, Dougados M, Rosenbaum JT, Mariette X, Sieper J, Melchers F, Cronstein BN, Breedveld FC, Kalden J, Smolen JS, Furst D. Unmet need in rheumatology: reports from the Targeted Therapies meeting 2019. Ann Rheum Dis 2019; 79:88-93. [PMID: 31662322 PMCID: PMC6937409 DOI: 10.1136/annrheumdis-2019-216151] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/04/2019] [Indexed: 12/30/2022]
Abstract
Objectives To detail the greatest areas of unmet scientific and clinical needs in rheumatology. Methods The 21st annual international Advances in Targeted Therapies meeting brought together more than 100 leading basic scientists and clinical researchers in rheumatology, immunology, epidemiology, molecular biology and other specialties. During the meeting, breakout sessions were convened, consisting of 5 disease-specific groups with 20–30 experts assigned to each group based on expertise. Specific groups included: rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus and other systemic autoimmune rheumatic diseases. In each group, experts were asked to identify unmet clinical and translational research needs in general and then to prioritise and detail the most important specific needs within each disease area. Results Overarching themes across all disease states included the need to innovate clinical trial design with emphasis on studying patients with refractory disease, the development of trials that take into account disease endotypes and patients with overlapping inflammatory diseases, the need to better understand the prevalence and incidence of inflammatory diseases in developing regions of the world and ultimately to develop therapies that can cure inflammatory autoimmune diseases. Conclusions Unmet needs for new therapies and trial designs, particularly for those with treatment refractory disease, remain a top priority in rheumatology.
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Affiliation(s)
| | | | - Joan Bathon
- Columbia University, College of Physicians & Surgeons, New York City, New York, USA
| | | | - Philip J Mease
- Swedish Medical Center, University of Washington, Seattle, Washington, USA
| | | | - Vivian Bykerk
- Hospital for Special Surgery, New York City, New York, USA
| | | | - James Todd Rosenbaum
- Oregon Health Sciences University, Portland, Oregon, USA.,Legacy Devers Eye Institute, Portland, Oregon, USA
| | - Xavier Mariette
- Paris-Sud University, APHP Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - Fritz Melchers
- Max Planck Institute for Infection Biology, Berlin, Germany
| | | | | | | | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of, Vienna, Vienna, Austria
| | - Daniel Furst
- Swedish Medical Center, University of Washington, Seattle, Washington, USA.,University of California, Los Angeles Medical Center, Los Angeles, CA, USA.,University of Florence, Florence, Italy
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11
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Yajima N, Tsujimoto Y, Fukuma S, Sada KE, Shimizu S, Niihata K, Takahashi R, Asano Y, Azuma T, Kameda H, Kuwana M, Kohsaka H, Sugiura-Ogasawara M, Suzuki K, Takeuchi T, Tanaka Y, Tamura N, Matsui T, Mimori T, Fukuhara S, Atsumi T. The development of quality indicators for systemic lupus erythematosus using electronic health data: A modified RAND appropriateness method. Mod Rheumatol 2019; 30:525-531. [PMID: 31111758 DOI: 10.1080/14397595.2019.1621419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: Quality indicators (QIs) are tools that standardize evaluations in terms of the minimum acceptable quality of care, presumably contributing for the better management of patients with systemic lupus erythematosus (SLE). This study aimed to develop QIs for SLE using electronic health data.Methods: The modified RAND/UCLA Appropriateness Method was used to develop the QIs. First, a literature review was conducted. Second, the candidate QI items that were available to be evaluated using the electronic health data were extracted. Third, the appropriateness of the items was assessed via rating rounds and panelists' discussions.Results: We found 3621 articles in the initial search. Finally, 34 studies were reviewed, from which 17 potential indicators were extracted as candidate QIs. Twelve indicators were selected as the final QI set through the process of appropriateness. The median appropriateness of these 12 indicators was at least 7.5, and all of them were without disagreement. The QI included assessment of disease activity, treatment of SLE, drug toxicity monitoring, treatment of glucocorticoid complications, and assessment of SLE complications.Conclusion: We formulated 12 QIs for the assessment of patients with SLE based on electronic medical data. Our QI set would be a practical tool as a quality measure.
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Affiliation(s)
- Nobuyuki Yajima
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.,Department of Nephrology and Dialysis, Kyoritsu Hospital, Kawanishi, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Sayaka Shimizu
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Kakuya Niihata
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ryo Takahashi
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshihide Asano
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Teruhisa Azuma
- Shirakawa Satellite for Teaching And Research in General Medicine, Fukushima Medical University, Shirakawa, Japan
| | - Hideto Kameda
- Division of Rheumatology, Toho University, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mayumi Sugiura-Ogasawara
- Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshihiro Matsui
- Department of Lifetime Clinical Immunology Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara Hospital, Sagamihara, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Liu LH, Choden S, Yazdany J. Quality improvement initiatives in rheumatology: an integrative review of the last 5 years. Curr Opin Rheumatol 2019; 31:98-108. [PMID: 30608250 PMCID: PMC7391997 DOI: 10.1097/bor.0000000000000586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW We reviewed recent quality improvement initiatives in the field of rheumatology to identify common strategies and themes leading to measurable change. RECENT FINDINGS Efforts to improve quality of care in rheumatology have accelerated in the last 5 years. Most studies in this area have focused on interventions to improve process measures such as increasing the collection of patient-reported outcomes and vaccination rates, but some studies have examined interventions to improve health outcomes. Increasingly, researchers are studying electronic health record (EHR)-based interventions, such as standardized templates, flowsheets, best practice alerts and order sets. EHR-based interventions were most successful when reinforced with provider education, reminders and performance feedback. Most studies also redesigned workflows, distributing tasks among clinical staff. Given the common challenges and solutions facing rheumatology clinics under new value-based payment models, there are important opportunities to accelerate quality improvement by building on the successful efforts to date. Structured quality improvement models such as the learning collaborative may help to disseminate successful initiatives across practices. SUMMARY Review of recent quality improvement initiatives in rheumatology demonstrated common solutions, particularly involving leveraging health IT and workflow redesign.
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Affiliation(s)
- Lucy H Liu
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
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Chu L, Kannan V, Basit MA, Schaeflein DJ, Ortuzar AR, Glorioso JF, Buchanan JR, Willett DL. SNOMED CT Concept Hierarchies for Computable Clinical Phenotypes From Electronic Health Record Data: Comparison of Intensional Versus Extensional Value Sets. JMIR Med Inform 2019; 7:e11487. [PMID: 30664458 PMCID: PMC6351992 DOI: 10.2196/11487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/23/2018] [Accepted: 12/09/2018] [Indexed: 01/19/2023] Open
Abstract
Background Defining clinical phenotypes from electronic health record (EHR)–derived data proves crucial for clinical decision support, population health endeavors, and translational research. EHR diagnoses now commonly draw from a finely grained clinical terminology—either native SNOMED CT or a vendor-supplied terminology mapped to SNOMED CT concepts as the standard for EHR interoperability. Accordingly, electronic clinical quality measures (eCQMs) increasingly define clinical phenotypes with SNOMED CT value sets. The work of creating and maintaining list-based value sets proves daunting, as does insuring that their contents accurately represent the clinically intended condition. Objective The goal of the research was to compare an intensional (concept hierarchy-based) versus extensional (list-based) value set approach to defining clinical phenotypes using SNOMED CT–encoded data from EHRs by evaluating value set conciseness, time to create, and completeness. Methods Starting from published Centers for Medicare and Medicaid Services (CMS) high-priority eCQMs, we selected 10 clinical conditions referenced by those eCQMs. For each, the published SNOMED CT list-based (extensional) value set was downloaded from the Value Set Authority Center (VSAC). Ten corresponding SNOMED CT hierarchy-based intensional value sets for the same conditions were identified within our EHR. From each hierarchy-based intensional value set, an exactly equivalent full extensional value set was derived enumerating all included descendant SNOMED CT concepts. Comparisons were then made between (1) VSAC-downloaded list-based (extensional) value sets, (2) corresponding hierarchy-based intensional value sets for the same conditions, and (3) derived list-based (extensional) value sets exactly equivalent to the hierarchy-based intensional value sets. Value set conciseness was assessed by the number of SNOMED CT concepts needed for definition. Time to construct the value sets for local use was measured. Value set completeness was assessed by comparing contents of the downloaded extensional versus intensional value sets. Two measures of content completeness were made: for individual SNOMED CT concepts and for the mapped diagnosis clinical terms available for selection within the EHR by clinicians. Results The 10 hierarchy-based intensional value sets proved far simpler and faster to construct than exactly equivalent derived extensional value set lists, requiring a median 3 versus 78 concepts to define and 5 versus 37 minutes to build. The hierarchy-based intensional value sets also proved more complete: in comparison, the 10 downloaded 2018 extensional value sets contained a median of just 35% of the intensional value sets’ SNOMED CT concepts and 65% of mapped EHR clinical terms. Conclusions In the EHR era, defining conditions preferentially should employ SNOMED CT concept hierarchy-based (intensional) value sets rather than extensional lists. By doing so, clinical guideline and eCQM authors can more readily engage specialists in vetting condition subtypes to include and exclude, and streamline broad EHR implementation of condition-specific decision support promoting guideline adherence for patient benefit.
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Affiliation(s)
- Ling Chu
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Vaishnavi Kannan
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mujeeb A Basit
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Diane J Schaeflein
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Adolfo R Ortuzar
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jimmie F Glorioso
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Joel R Buchanan
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Duwayne L Willett
- University of Texas Southwestern Medical Center, Dallas, TX, United States
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The Potential and Pitfalls of Using the Electronic Health Record to Measure Quality. Am J Gastroenterol 2018; 113:1111-1113. [PMID: 29887597 DOI: 10.1038/s41395-018-0140-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/30/2018] [Indexed: 12/11/2022]
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FitzGerald JD, Mikuls TR, Neogi T, Singh JA, Robbins M, Khanna PP, Turner AS, Myslinski R, Suter LG. Development of the American College of Rheumatology Electronic Clinical Quality Measures for Gout. Arthritis Care Res (Hoboken) 2018; 70:659-671. [DOI: 10.1002/acr.23500] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/12/2016] [Indexed: 01/22/2023]
Affiliation(s)
| | - Ted R. Mikuls
- VA Nebraska-Western Iowa Health Care System; and University of Nebraska Medical Center; Omaha
| | - Tuhina Neogi
- Boston University School of Medicine; Boston Massachusetts
| | - Jasvinder A. Singh
- Birmingham Veterans Affairs Medical Center; and University of Alabama at Birmingham
| | - Mark Robbins
- Harvard Vanguard Medical Association; Somerville Massachusetts
| | - Puja P. Khanna
- University of Michigan; and VA Ann Arbor Healthcare System; Ann Arbor Michigan
| | | | | | - Lisa G. Suter
- Yale University, New Haven, Connecticut; and West Haven Veterans Affairs Medical Center; West Haven Connecticut
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