Poster Presented at the 2015 ACR/ARHP Annual MeeQng

Transcription

1 Poster Presented at the 2015 ACR/ARHP Annual MeeQng November 6-11, 2015 San Francisco, CA Abstract # 2317 Gary Crump 1 James Bower 2 Terrence Foley 3 J Timothy Harrington 2 Nikita Hegde 4 Drew Johnson 2 Rafia Khalil 5 Edmund LaCour 6 Robert Perhala 7 1 Rheumatology Associates Louisville, Louisville, KY 2 Joiner Associates LLC, Madison, WI 3 Terrance Foley MD Inc, Concord, OH 4 Akron General Hospital, Akron, OH 5 Rafia Khalil ArthriMs and Rheumatology Center PC, Port Huron, MI 6 Dothan Medical Associates PC, Dothan, AL 7 University Hospitals, Cleveland, OH

2 Background/Purpose Accurate rheumatoid arthrims (RA) disease acmvity assessment is required for treatment consistent with Treat- to- Target (T2T) recommendamons. Rheumatologists currently use a variety of pament- generated, physician- generated, and laboratory data to assess RA disease acmvity (DA). Discordance among different clinical measures, and more recently between clinical measures and a mulm- biomarker test, has been documented. This study invesmgates discordance among DA measures in mulmple clinical pracmce RA populamons. Methods The Rheumatoid ArthriMs PracMce Performance (RAPP) Project is a voluntary collaboramon of U.S. clinician rheumatologists whose goal is to provide T2T care and opmmal RA disease outcomes. Of the 168 parmcipants in the RAPP Project, 86 have enrolled their enmre RA populamon (ICD- 9 code 714.0) in a HIPAA- compliant disease populamon registry and are tracking DA measures in the registry. With isolated excepmons, their preferred measures include one or more of the following: a 0-10 Provider Global Assessment (PGA), Clinical Disease AcMvity Index (CDAI), RAPID3, and a mulm- biomarker (MB) test. Table 1 reports the number of registries tracking each of these measures and the distribumons of controlled, low, moderate, and high DA for each measure using the most recent assessment for each pament. Table 2 reports discordance rates between different date- matched DA results from those registries entering more than one measure, again using the most recent assessment for each pament. Results Table 1. DA DistribuMons for Different Measures in 86 RAPP PracMce Registries RAPID3 PGA CDAI MB Registries tracking (N) Controlled and low DA (median %) 52% 74% 55% 22% Moderate DA (median %) 22% 21% 27% 39% High DA (median %) 26% 5% 19% 39% Table 2. Discordance among Paired DA Measures MB MB MB CDAI CDAI PGA vs vs vs vs vs vs CDAI PGA RAPID3 PGA RAPID3 RAPID3 Registries included (N) Measure pairs (#) Discordance (median %) 44% 41% 33% 17% 26% 32% Discordance range 41-49% 18-59% 24-42% 15-18% 5-41% 20-71% Conclusion 1. Different measures provide differing DA distribumons within RA populamons and discordant results for many individual paments. 2. Treatment decisions will likely differ based on which measures are used. 3. Factors contribumng to discordance among measures at the populamon and pament levels appear to include paments and providers variable subjecmve percepmons, variability of joint examinamons, and sub- clinical inflammamon detected only by MB tesmng

3 The Rheumatoid ArthriQs PracQce Performance (RAPP) Project is a voluntary collaboramon of 168 U.S. clinician rheumatologists who manage more than 80,000 rheumatoid arthrims (RA) paments in total. Clinical populaqon management offers a promising approach to providing Treat- to- Target care for RA. It depends on providing standardized, on- Mme disease acmvity assessments and coordinated care across the enmre disease populamon, as well as for individual paments within this context. Rheumatologists currently use a variety of clinical and laboratory measures to assess RA disease acmvity. Discordance among these measures has been documented. This study invesqgates this discordance in mulmple clinical pracmce RA populamons

4 RHEUMATOID ARTHRITIS PRACTICE PERFORMANCE (RAPP) PROJECT Dataflow Process: We developed a simple, doable clinical populamon management process. RAPP Project PracQces Included in Study: Had all their RA paments enrolled in a populamon registry. (N=86) 2015 STEP Document paqent data Enter data in populaqon registry TOOLS 2 PaQent Data CollecQon Sheet PopulaQon registry WHO 1 Physician/ pracqce team 3 Analyze populaqon data 4 Improve care and workflows PopulaQon data and paqent work lists PracQce staff or designated registry manager For Table 1, were documenmng one or more measures in registry. (N=86) For Table 2, were documenmng two or more measures in registry. (N=27) PracQce team 4

5 Table 1. DA DistribuQons for Different Measures in 86 RAPP Project PracQce Registries. RAPID3 PGA CDAI Test Registries Tracking (N) Controlled and Low Disease AcQvity (median %) Moderate Disease AcQvity (median %) High Disease AcQvity (median %) % 74% 55% 22% 22% 21% 27% 39% 26% 5% 19% 39%

6 Table 2. Discordance among Paired DA Measures. vs CDAI vs PGA vs RAPID3 CDAI vs PGA CDAI vs RAPID3 PGA vs RAPID3 Registries Included (N) Measure Pairs (#) Discordance (median %) 44% 41% 33% 17% 26% 32% Discordance Range 41-49% 18-59% 24-42% 15-18% 5-41% 20-71%

7 1. Different measures provide differing DA distribumons within RA populamons and discordant results for many individual paments. 2. Treatment decisions will likely differ based on which measures are used. 3. Factors contribumng to discordance among measures at the populamon and pament levels appear to include paments and providers variable subjecmve percepmons, variability of joint examinamons, and sub- clinical inflammamon detected only by mulm- biomarker tesmng. Disclosures G Crump, J Bower, T Foley, JT Harrington, N Hegde, R Khalil, E LaCour, R Perhala, Crescendo Bioscience 5 G Crump, R Perhala, Crescendo Bioscience 8 D Johnson, Crescendo Bioscience 3 (formerly) Joiner Associates LLC received consulmng fees from Crescendo Bioscience for designing and coordinamng the Rheumatoid ArthriMs PracMce Performance (RAPP) Project without any influence from the company Crescendo Bioscience provided consulmng fees to Joiner Associates and support for RAPP Project advisory board meemngs 3 Employment (full or part Mme) 5 ConsulMng fees or other remuneramon (payment) 8 Speaker s bureau