Sapir Tamar, Rusie Erica, Greene Laurence, Yazdany Jinoos, Robbins Mark L, Ruderman Eric M, Carter Jeffrey D, Patel Barry, Moreo Kathleen
PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA.
Division of Rheumatology, Department of Medicine, University of California, San Francisco, Box 0920, 3333, California St., Suite 270, San Francisco, CA, 94143-0920, USA.
Rheumatol Ther. 2015 Dec;2(2):141-151. doi: 10.1007/s40744-015-0018-7. Epub 2015 Oct 1.
In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists' performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-education chart audits.
Twenty community-based rheumatologists across the United States were recruited to participate in the QI education program and chart audits. Charts were retrospectively audited before (n = 160 charts) and after (n = 160 charts) the rheumatologists participated in a series of accredited QI-focused educational activities that included private audit feedback, small-group webinars, and online- and mobile-accessible print and video activities. The charts were audited for patient demographics and the rheumatologists' documented performance on the 6 quality measures for RA included in the Physician Quality Reporting System (PQRS). In addition, charts were abstracted for documentation of patient counseling about medication benefits/risks and adherence, lifestyle modifications, and quality of life; assessment of RA medication side effects; and assessment of RA medication adherence.
Mean rates of documented performance on 4 of the 6 PQRS measures for RA were significantly higher in the post-education versus baseline charts (absolute increases ranged from 9 to 24% of patient charts). In addition, after the intervention, significantly higher mean rates were observed for patient counseling about medications and quality of life, and for assessments of medication side effects and adherence (absolute increases ranged from 9 to 40% of patient charts).
This pragmatic study provides preliminary evidence for the positive influence of QI-focused education in helping rheumatologists improve performance on national quality measures for RA.
近年来，研究人员报告了类风湿性关节炎（RA）患者所接受护理质量存在缺陷，包括质量指标的执行率较低。我们试图确定质量改进（QI）继续教育项目对风湿病学家在RA国家质量指标方面的表现以及与国家质量战略重点一致的其他指标的影响。通过基线和教育后图表审核来评估表现。
招募了美国20名社区风湿病学家参与QI教育项目和图表审核。在风湿病学家参加一系列经认可的以QI为重点的教育活动之前（n = 160份图表）和之后（n = 160份图表），对图表进行回顾性审核。这些教育活动包括私人审核反馈、小组网络研讨会以及在线和移动可访问的印刷品和视频活动。审核图表以获取患者人口统计学信息以及风湿病学家在医师质量报告系统（PQRS）中包含的6项RA质量指标上的记录表现。此外，提取图表以记录患者关于药物益处/风险和依从性、生活方式改变以及生活质量的咨询；RA药物副作用的评估；以及RA药物依从性的评估。
在教育后图表中，6项RA的PQRS指标中有4项的记录表现平均率显著高于基线图表（患者图表的绝对增加范围为9%至24%）。此外，干预后，在患者关于药物和生活质量的咨询以及药物副作用和依从性的评估方面，观察到平均率显著更高（患者图表的绝对增加范围为9%至40%）。
这项务实的研究为以QI为重点的教育在帮助风湿病学家提高RA国家质量指标表现方面的积极影响提供了初步证据。
