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J Manag Care Spec Pharm. 2015 Feb;21(2):135-43. doi: 10.18553/jmcp.2015.21.2.135.
Health care quality problems are reflected in the underuse, overuse, and misuse of health care services. There is evidence suggesting that the quality of rheumatoid arthritis (RA) patient care is suboptimal, which has spurred the development of a number of systematic quality improvement metrics.
To investigate a quality process measurement set in a sample of commercially insured RA patients.
Medical, pharmacy, and laboratory claims for members with an RA diagnosis (ICD-9-CM 714.x) during calendar years 2008 through 2012 were extracted from the Optum Clinformatics Data Mart database. Eight process quality measures focused on RA patient response and tolerance to therapy were examined in the claims database. Measures were calculated for individual calendar years from 2009 to 2012, inclusive.
The majority of adult RA patients received at least 1 prescription for a disease-modifying antirheumatic drug (DMARD) across the 4 measurement years: range = 78.5%-81.6%. Erythrocyte sedimentation rate and C-reactive protein testing were also evident in the majority of the sample, with 67.1%-72.2% of newly diagnosed RA patients receiving baseline testing, and 56.0%-58.7% of existing RA patients receiving annual testing. Among methotrexate users, liver function tests were performed in 74.5%-75.7% of treated patients, serum creatinine tests in 70.1%-72.6% of patients, and complete blood count tests in 74.5%-76.0% of patients. Additionally, most patients initiating a new DMARD had a claim for a baseline serum creatinine test (68.0%-70.3%) and baseline liver function test (69.3%-71.0%).
Findings suggest that a majority of RA patients are attaining patient quality process measures, although a considerable proportion of patients (approximately 25%) may be receiving suboptimal care. Further studies are warranted to understand whether attainment of these measures translates into better outcomes.
医疗保健质量问题反映在医疗服务的使用不足、过度使用和使用不当上。有证据表明，类风湿关节炎 (RA) 患者的护理质量不高，这促使开发了许多系统性的质量改进指标。
调查一组商业保险 RA 患者样本中的质量过程测量集。
从 Optum Clinformatics Data Mart 数据库中提取了 2008 年至 2012 年期间患有 RA 诊断（ICD-9-CM 714.x）的成员的医疗、药房和实验室索赔。在索赔数据库中检查了八项针对 RA 患者对治疗的反应和耐受性的过程质量措施。从 2009 年到 2012 年，每年都计算了这些措施。
在 4 年的测量期间，大多数成年 RA 患者至少收到了一种疾病修饰抗风湿药物 (DMARD) 的处方：范围=78.5%-81.6%。红细胞沉降率和 C 反应蛋白检测在样本中也很明显，67.1%-72.2%的新诊断 RA 患者接受基线检测，56.0%-58.7%的现有 RA 患者接受年度检测。在使用甲氨蝶呤的患者中，74.5%-75.7%的治疗患者进行了肝功能检查，70.1%-72.6%的患者进行了血清肌酐检查，74.5%-76.0%的患者进行了全血细胞计数检查。此外，大多数开始新 DMARD 的患者都有基线血清肌酐检查（68.0%-70.3%）和基线肝功能检查（69.3%-71.0%）的索赔。
研究结果表明，大多数 RA 患者达到了患者质量过程指标，但相当一部分患者（约 25%）可能接受的护理质量不高。需要进一步研究以了解这些措施的实现是否转化为更好的结果。
