ACR Quality of Care Committee Impresses with Its Recent Productivity

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Over the past 18 months, the ACR’s Quality of Care (QOC) Committee has helped produce an impressive number of resources that will help rheumatologists deliver the best possible care. Working through specific projects supervised under its Criteria, Guideline, Guidance, and Quality Measure subcommittees, the QOC Committee has developed new sets of disease criteria, clinical guidelines, guidance documents and quality assessment measures across multiple domains of rheumatology.

QOC

The QOC Committee plays a critical role in ensuring that products developed and endorsed by the ACR achieve a high level of methodologic rigor and clinical applicability. The QOC subcommittees help review and shape products (e.g., a specific guideline or guidance document) developed under their purview. Then, the near-final product is sent to the QOC Committee, an independent group of volunteers, which provides another layer of independent review, before the document is sent to the ACR Board of Directors for potential ACR endorsement.

The chair of the QOC Committee is Sindhu Johnson, MD, PhD, an associate professor in the Division of Rheumatology at the University of Toronto. Several projects taken on by the QOC Committee in recent years have either recently been published or are expected to be soon. “A small army of individuals has given hundreds of hours of volunteer service to produce these,” Dr. Johnson says. “The exceptional productivity from the QOC Committee has led to substantial value for ACR members.”

Dr. Johnson

In addition to Dr. Johnson, 11 members currently sit on the QOC Committee, and the four distinct QOC subcommittees include another 50 or so individuals. Considering the many different projects overseen by these committees, many dozens of individuals have given their time to support these projects.

Service on these committees ranges from two to four years. For individuals volunteering to serve on a specific project (e.g., vasculitis guidelines), the time commitment may extend longer, depending on a particular project’s scope.

Dr. Johnson notes the COVID-19 pandemic has not significantly delayed many of the projects underway, and in fact, four new COVID-19 guidance projects were added. “It is really a testament to the commitment of the investigators; nearly all of the volunteers are clinicians and have had increased clinical load due to the pandemic, yet they have seen these projects through to completion,” she says.

‘Due to the nature of the articles, the Guidance Subcommittee members work in sprints to turn around articles as quickly as possible.’ —Dr. FitzGerald

Criteria Subcommittee

The Criteria Subcommittee oversees various projects related to developing better classification, response and remission criteria. High-quality, rigorous criteria are essential for developing well-designed research studies.

Dr. Johnson highlights the huge body of work the subcommittee has overseen related to different vasculitis subtypes criteria, the synthesis of work completed over several years. Three papers will be published this summer on eosinophilic granulomatosis with polyangiitis (EGPA), granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). Also of note was the publication in 2020 of classification criteria for IgG4- related disease, a previously unrecognized entity that had only been described as disparate syndromes.¹

Many other projects overseen by the Criteria Subcommittee are ongoing, including criteria for additional vasculitis subtypes, antiphospholipid syndrome, antisynthetase syndrome, calcium pyrophosphate dihydrate crystal deposition disease (CPPD) and pediatric chronic recurrent multifocal osteomyelitis (CRMO).

Dr. Lacaille

The chair of the Criteria Subcommittee is Diane Lacaille, MD, MHSc, a professor in the Division of Rheumatology at the University of British Columbia, Vancouver, Canada. “I wish to express my gratitude to the members of the Criteria Subcommittee,” says Dr. Lacaille, “for finding precious time in their very busy schedules for reviewing proposals and manuscripts. Without them, our important work would not be possible.”

Guideline Subcommittee

The Guideline Subcommittee has also recently seen several projects come to fruition. These span subjects across rheumatic diseases: osteoarthritis, gout, multiple types of vasculitis, Lyme disease, juvenile idiopathic arthritis and rheumatoid arthritis.^2-4

“Taking vasculitis as an example,” says Dr. Johnson, the volunteers “have had unprecedented output, with four guidelines and six literature review papers coming out soon. We are going to see publication of these papers across all three ACR publications: Arthritis & Rheumatology, Arthritis Care & Research and ACR Open Rheumatology.”

The chair of the Guideline Subcommittee is Susan M. Goodman, MD, a professor of medicine at Weill Cornell Medicine, New York City. “The committee has stepped up in the past year during the COVID pandemic as we all shifted priorities to recognize our new challenges,” says Dr. Goodman. “This has been a great group of committed rheumatologists, working closely with the amazing ACR administrative staff.”

Guidance Subcommittee

Dr. Goodman

Established in early 2020 to meet a need to address topics better suited to swift dissemination, the Guidance Subcommittee is the newest subcommittee under the QOC Committee. Its chair is John D. FitzGerald, MD, PhD, the clinical chief of the Division of Rheumatology at the David Geffen School of Medicine, University of California, Los Angeles.

“Guidance documents are topical, timely reviews that are meant to provide useful clinical direction to members through an evidence review and consensus development process,” says Dr. FitzGerald. “Due to the nature of the articles, the Guidance Subcommittee members work in sprints to turn around articles as quickly as possible.”

Recent ACR guidance includes recommendations on the management of adult and pediatric patients with COVID-19, as well as COVID-19 vaccines.^5-8 Guidance on hydroxychloroquine cardiac safety has recently been approved by the ACR and is now under review by Arthritis & Rheumatology.

Quality Measure Subcommittee

The Quality Measure Subcommittee has oversight of projects that produce clinically meaningful and relevant quality measures, such as those that can be used to assess how well a practice is doing in controlling disease activity in rheumatoid arthritis patients.

Dr. FitzGerald

Lisa G. Suter, MD, a professor of medicine in the Section of Rheumatology at Yale University School of Medicine, New Haven, Conn., co-chairs the subcommittee with Alex Limanni, MD, a rheumatologist with Arthritis Centers of Texas, Dallas. “I’m deeply grateful for the amazing work the Quality Measure Subcommittee members, additional volunteers and ACR staff have been able to accomplish despite the upheaval and uncertainty of the pandemic,” says Dr. Suter.

The Quality Measure Subcommittee has published an article defining preferred patient-reported functional status assessments and an update on disease activity assessments in rheumatoid arthritis.^9,10 Using these survey instruments, the group also moved forward with the ACR’s first risk-adjusted outcome measure (i.e., a measure of rheumatoid arthritis disease activity), as well as its first patient-reported outcome-based performance measure (i.e., a measure of rheumatoid arthritis functional status).

Dr. Suter

“We also continue to work with [the ACR Registries and Health Information Technologies Committee], the [ACR Committee on Rheumatologic Care] and other committees to advance value-based payment in ways that will protect and improve care for our patients while ensuring clinicians are adequately reimbursed,” Dr. Suter adds.

Volunteering

Dr. Johnson is appreciative of the hard work done by all the volunteers on the QOC Committee, the subcommittees and the participants on individual projects under QOC Committee supervision. “On behalf of the QOC Committee, I would like to extend a sincere thank you to the chairs, the committee members and the investigators on all of these projects,” says Dr. Johnson.

Dr. Limanni

ACR members are encouraged to lend their expertise to QOC activities and projects. Every spring, the ACR begins a new nomination process to find new QOC Committee members (now closed for 2021–22). The ACR also lets its membership know when participants are needed for new projects that fall under the QOC Committee purview. Additionally, members can email Regina Parker with their areas of interest and curriculum vitae, and she can alert the relevant committee and project chairs about an individual’s interest and availability ([email protected]).

Dr. Johnson speaks to the satisfaction this kind of work can bring. “When you see a project through to completion that you know is going to help the patients you see, that brings significant gratification.”

Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.