1910: Development of the American College of Rheumatology Toolkit for Implementation of Rheumatoid Arthritis Outcome Measures in Clinical Practice

Catherine Nasrallah¹, Lindsay Jacobsohn¹, Gabriela Schmajuk², Emma Kersey¹, Cammie Young³, Cammie Young³, Janell Martin⁴, Lori Barber⁵, Jennifer Barton⁶, Puneet Bajaj⁷, Christie M. Bartels⁸, Sancia Ferguson⁹, Elizabeth Wahl¹⁰, Kimberly DeQuattro¹¹, Patti Katz¹², Maria I. (\"Maio\") Danila¹³, Meera Subash¹⁴, Christina Downey¹⁵, JoAnn Zell¹⁶, Kimberly Reiter¹⁷, Elena Weinstein¹⁸ and Jinoos Yazdany¹, ¹University of California San Francisco, San Francisco, CA, ²UCSF / SFVA, San Francisco, CA, ³University of California San Francisco, Oakland, CA, ⁴American College of Rheumatology, Atlanta, GA, ⁵ACR, Atlanta, GA, ⁶VA Portland Health Care System/OHSU, Portland, OR, ⁷UT Southwestern Medical Center, Dallas, TX, ⁸University of Wisconsin, School of Medicine and Public Health, Madison, WI, ⁹University of Wisconsin, Madison, WI, ¹⁰VA Puget Sound Healthcare System, Seattle, WA, ¹¹University of Pennsylvania, Media, PA, ¹²University of California San Francisco, San Rafael, CA, ¹³University of Alabama at Birmingham (UAB), Birmingham VA Medical Center, Birmingham, AL, ¹⁴University of Texas Health Science Center at Houston, Houston, TX, ¹⁵Loma Linda University Medical Center, Loma Linda, CA, ¹⁶University of Colorado Anschutz Medical Campus, Denver, CO, ¹⁷Albuquerque VA Medical Center, Albuquerque, NM, ¹⁸University of Colorado, Englewood, CO

Background/Purpose: Despite significant interest in the scale and spread of rheumatoid arthritis (RA) outcome measures to facilitate a patient-centered, treat-to-target approach, use of these measures remains inconsistent among rheumatologists. We used the Consolidated Framework for Implementation Research (CFIR) to guide qualitative interviews with stakeholders about facilitators and barriers to RA outcome measurement in real-world rheumatology care, with the goal of disseminating best practices for implementation via an online toolkit

Methods: Using RISE registry data, we invited 85 practices with high performance on RA disease activity (DA) measures (≥ 50% percentile on the Quality Payment Program (QPP) 177 periodic assessment of DA) and 54 practices with lower performance to participate. Because academic medical centers (AMCs) are under-represented in RISE, 4 AMCs were also invited to participate. Rheumatologists and key staff from each practice participated in virtual interviews. CFIR concepts were used to develop a semi-structured interview guide to understand workflows, facilitators, and barriers to RA outcome measure collection. Interview recordings were transcribed verbatim and analyzed thematically using deductive and inductive techniques to generate themes and subthemes. Collaborating with the ACR staff, we compiled information from these interviews to develop the online RA Toolkit, a comprehensive resource to facilitate RA outcome measurement in clinical practice (Figure 1).

Results: Interviews were conducted with invited practices until thematic saturation was reached (38 interviews across 16 RISE practices and 4 AMC). Participants included 21 rheumatologists, 8 medical assistants, 6 practice managers, 1 nurse practitioner, and 2 information technology specialists. Each interview highlighted unique innovations, resources, best practices, and challenges for collecting RA outcome measures (select findings summarized in Table 1). Results of the qualitative interviews, ACR guidelines regarding RA outcome measures, and other evidence-based resources were compiled in the RA Toolkit (available at RAToolkit.kotobee.com). The Toolkit is a multimedia online resource for RA outcome measure implementation geared toward use by clinicians and staff. Sections include text, videos, and downloadable forms that aid in understanding and using RA outcome measures in clinical practice, recommendations and best practices identified from high performers across diverse practice settings and EHRs, training resources for staff, and validated translations of available RA measures in Spanish and Chinese (Figure 2).

Conclusion: Qualitative interviews conducted with rheumatology teams laid the groundwork to develop a best practices implementation toolkit to disseminate innovations in RA measures collection. The ACR RA Toolkit is the first comprehensive, evidence-based, open-source resource available for rheumatologists and healthcare teams to guide effective implementation, collection, and use of RA outcome measures that promote quality and value-based patient-centered care.








C. Nasrallah: None; L. Jacobsohn: None; G. Schmajuk: None; E. Kersey: None; C. Young: None; C. Young: None; J. Martin: None; L. Barber: None; J. Barton: None; P. Bajaj: None; C. Bartels: Pfizer, 5; S. Ferguson: None; E. Wahl: None; K. DeQuattro: None; P. Katz: None; M. Danila: Horizon, 5, Pfizer, 5, RheumNow, 2, UCB, 2; M. Subash: None; C. Downey: None; J. Zell: None; K. Reiter: None; E. Weinstein: Priovant, 5; J. Yazdany: Astra Zeneca, 2, 5, Aurinia, 5, Gilead, 5, Pfizer, 2.