University of California, San Francisco.
University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California.
Arthritis Care Res (Hoboken). 2024 Jul;76(7):1037-1044. doi: 10.1002/acr.25318. Epub 2024 Mar 18.
We combined claims and electronic health record (EHR) data to provide contemporary and accurate estimates of latent tuberculosis (TB) screening among new users of a biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) and assess potential gaps in testing by drug type, patient characteristics, and practice.
Our denominator population was patients in the Rheumatology Informatics System for Effectiveness (RISE) registry and Medicare using a b/tsDMARD in 2018 without a claim or prescription in the year prior. TB screening was assessed in both Medicare and RISE 1 and 3 years before the medication start date. We calculated the proportion screened overall, by medication class, and by practice. We tested for demographic differences in screening using logistic regression.
In the year before drug starts, 65.6% of patients had any TB screening; in a 3-year window, 72.9% had any TB screening. Rates of screening within 1 year by drug type were greater or equal to the overall screening rate for most drugs except for JAK inhibitors (JAKis) (46%) and interleukin-17 inhibitors (IL-17is) (11.5%). A lower proportion of Hispanic and Asian patients were screened compared with White patients. Practice screening rates ranged from 20.0% to 92.9% of patients within 1 year.
We report higher screening rates than have previously been published because of combining claims and EHR data. However, important safety gaps remain, namely, reduced screening among new users of a JAKi or IL-17i and among Asian and Hispanic patients, as well as low-performing practices. Educational initiatives, team-based care delivery, task shifting, and technological interventions to address observed gaps in patient safety procedures are needed.
我们结合索赔和电子健康记录（EHR）数据，提供了生物制剂或靶向合成疾病修饰抗风湿药物（b/tsDMARD）新使用者中潜伏性结核病（TB）筛查的最新且准确估计，并评估了药物类型、患者特征和实践等方面检测的潜在差距。
我们的分母人群是在 2018 年使用 b/tsDMARD 的风湿病信息系统（RISE）登记处和 Medicare 中没有在该年前一年索赔或处方的患者。在药物开始日期之前的 1 年和 3 年内，我们评估了 Medicare 和 RISE 中的 TB 筛查情况。我们按药物类别和实践计算了总体筛查率、按药物类别筛查率和按实践筛查率。我们使用逻辑回归测试了筛查中的人口统计学差异。
在开始用药前的一年中，65.6%的患者接受了任何 TB 筛查；在 3 年的时间窗口内，72.9%的患者接受了任何 TB 筛查。除 JAK 抑制剂（JAKi）（46%）和白细胞介素-17 抑制剂（IL-17i）（11.5%）外，大多数药物的药物类型内 1 年内的筛查率均高于或等于总体筛查率。与白人患者相比，西班牙裔和亚洲患者的筛查比例较低。在 1 年内，有 20.0%至 92.9%的患者接受了实践筛查。
我们报告的筛查率高于之前发表的报告，因为我们结合了索赔和 EHR 数据。然而，仍然存在重要的安全差距，即新使用 JAKi 或 IL-17i 的患者以及亚洲和西班牙裔患者的筛查率降低，以及表现不佳的实践。需要采取教育举措、团队式护理服务、任务转移和技术干预措施来解决观察到的患者安全程序差距。
