Using informational systems to measure practice-wide clinical quality parameters and for improving clinical outcomes at the point of care are the pivotal to benchmarking. The benchmarking aspect of this model will allow rheumatology centers to compare providers within their own centers of similar size providing comparable services. Benchmarking will also be the basis of establishing rewards and incentives by governmental and private insurers for quality, value and outcomes in the delivery of rheumatic care. The continual end result of this initiative will be the establishment of positive, measurable standards while also creating the Rheumatology Specialty Medical Home to raise the standards throughout the health care system for the ultimate benefit of the patient by:

  • Improve patient care and patient experience
  • Improve the overall health of populations
  • Reduce the per capita cost of health care

Quality Improvement Plan

Step 1
Quality Improvement Plan

Participating Partners are given instant feedback about their quality of care, data completeness and accountability for improvement. Groups and hospitals use this feedback to guide QI efforts. Twice a year, the WRA Quality Improvement committee will post the progress of all practices, through a secure “membership” only with aggregated data of how we all measured up collectively together on meeting our quality improvement metrics. This “roll-up” reporting will be able show how an individual practice measures up against the peers of others in the state, but also can show how we measure up against other regions of the nation as well.

Additional information on the standards covered in each assessment, the categories of participation, and definitions of terms related to the assessment process/participation status can be made available.

Step 2
Quality Improvement Plan

The action plan for the year 2015 includes the following four major objectives:

The results of trend-analyses across the nation will drive and support our efforts in proving information to hospitals, state societies, and physicians to achieve their QI goals.

  1. Provide meaningful and active (timely, valid, reliable, pertinent) information to hospitals, providers and payers: WRA will provide periodic (quarterly, annual, cumulative) reports that include descriptive and risk-adjusted information, as well as comparisons to national benchmarks
  2. Identify and highlight key indicators of quality for QI focus among all Rheumatology participants with the goal of improving clinical outcomes across the state. Each indicator has been selected based on the presence of a solid base of evidence to support its links to improved clinical outcomes and lower costs, its effect on large numbers of patients in the state, and the presence of wide variability in performance among community practices and hospitals.

Step 3
Quality Indicators Measured

The indicators are used to significantly improve quality and measured “Gaps of Care and Variance” in the following areas of clinical focus:

  • Patient delay in presenting to Primary Care Physician
  • Lack of recognition of RA by Primary Care Physician
  • Delayed referral to Rheumatologist
  • Nonstrategic and poor coordination approach to care
  • Lack of a standardized tool or instrument to assess quality standards by peer consensus (and hold institutions accountable to those standards)
  • Gaps or variation in care for Rheumatoid Arthritis patients
  • Lack of a standard tool for assessing disease activity
  • Undesirable variation of standard of care principals in community practices and hospitals
  • Poor patient adherence to treatment and patient engagement

Step 4
Perform trend-tracking analysis using the information as described in #1 above

Automatic emails dashboards from JointMan® will activate the continuous quality improvement system for hospitals and community practices with any process or outcome measure that is outside the 95% confidence interval of the state mean for that parameter. This process will consist of

(a) notifying the site of the finding,

(b) request for a site response that will outline a plan of action and a time frame for improvement,

(d) a returned MC review of the proposal in a blinded and de-identified format, and

(e) re-measurement and review by MC after specified time interval

Example use case study: practitioners not completing Discontinuation reasons

Step 5
Annual assessment of participation status in Quality Improvement-RA program

Hospitals and community participants must make continued and full efforts to participate before a hospital’s status is changed from “participating in full compliance with community QI standards,” that hospital or community group will have an opportunity to audit its data. Any action relevant to participation status must be approved by 2/3 vote of Management

Step 6
The definition of “participating in full compliance with community QI standards

(A full description of quality improvement indicators will be provided to each participants)

  1. Data completeness: at least 90% of eligible Diagnosed RA cases are submitted (verified by Committee)
  2. Data reliability: at least 90% score on inter-rater reliability tests
  3. Data timeliness: Hospital submits data for all four quarters by the annual due date

Step 7
Quality Improvement Certified

As described in 3 above, a hospital or group that has any process or outcome measure that is outside the 95% confidence interval of the state mean for that parameter (a) has an acceptable improvement plan in process, and (b) does not exceed the threshold of persistent outliers upon re-measurement.