A Tuesday morning session will review the preliminary results of the 2016-2017 ACR Update on Rheumatoid Arthritis Disease Activity Measures and 2016-2017 ACR Rheumatoid Arthritis Functional Status Measures. Presenters will discuss the implications and impact of these new recommendations on researchers, clinicians, and healthcare policymakers.
The management of rheumatoid arthritis (RA)has changed dramatically in recent decades. For many years, U.S. rheumatologists did not routinely use standardized measures of RA, which prompted the ACR to convene a working group charged with creating disease-activity measures relating to the care of RA, published in 2011.
Because there has been considerable accrual of evidence for existing and novel disease activity measures, the ACR has convened another working group to evaluate information from newer research in the medical literature. Additionally, the ACR, for the first time, convened a working group to provide recommended functional status measures in RA.
Bryant England, MD, Assistant Professor in the Division of Rheumatology and Immunology at the Nebraska-Western Iowa VA Health Care System & University of Nebraska Medical Center, will discuss RA disease activity measures for use in rheumatology clinics. In addition to new research, healthcare policy factors contributed to the need to update recommendations, he said.
“There is much more interest in meeting quality benchmarks with MIPS (Merit-based Incentive Payment System) and MACRA (Medicare Access and CHIP Reauthorization Act). Federal regulations on reporting the quality of care have taken off,” Dr. England said.
Through a systematic review of the literature since the prior project, researchers found new studies published on the measures already in use and studies of new disease activity measures, including patient-reported components (such as patient global assessment of disease, physical function, pain, etc.), clinical assessments, imaging modalities, and blood tests.
Claire Barber, MD, PhD, Assistant Professor in the Departments of Medicine and Community Health Sciences at the University of Calgary, Alberta, Canada, and Clinical Scientist with Arthritis Research Canada, will report on ACR functional status measures.
Similar to the approach taken by the disease activity group, Dr. Barber will be presenting results of a systematic review on patient-reported functional status measures examined over a much longer period of time. The study will not only identify the existing measures but appraise their development and results using a standardized framework called COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments). While the current study is focused on identifying and making recommendations on the use of functional measures in patients with RA, many of the same measures identified may likely be useful by patients with other diagnoses in a rheumatology clinic.
Kaleb Michaud, PhD, Associate Professor in the Division of Rheumatology and Immunology at the University of Nebraska Medical Center and Co-Director of the National Data Bank for Rheumatic Diseases, will discuss the implications of the ACR RA disease activity and rheumatology functional status measures for researchers, practitioners, and policy makers. He will also solicit feedback from ACR members regarding the proposed measures.
“We have two talented teams that have worked hard over the past year to bring clarity and guidance to the many measures out there,” he said. “While I don’t expect everyone to use the same measure in their clinic, I do hope these will help align what is captured in EMRs for now and as our measures improve over time.”
All three speakers agree that the goal is to make recommendations on RA disease activity measures and functional status measures that can be implemented in clinical settings to improve patient outcomes. Dr. England emphasizes that the project is still ongoing, and that the speakers will share their findings in advance of new measures being published.
The session will also provide participants with an opportunity to discuss and provide comments and suggestions — as physicians on the front lines of healthcare — before the finalization of the measures in 2018. The expectation is that new measures will lead to improvements in treatment.
“The goal is to produce a product of recommended disease activity and functional measures that have been rigorously assessed in terms of psychometric properties for routine use in clinic,” said Dr. England. “A list of high-quality disease activity and functional status measures will aid clinicians in providing high-quality care to RA patients.”