He noted that it’s not just a matter of collecting the data in the clinic, but organizing it into a repository of the data in a usable format.
Options for analyzing the data and giving feedback range from static reports to face-to-face meetings to interactive reports and graphics. A lot isn’t known about the best way to give feedback, but it’s fairly well established that prompt feedback is best and that simply telling people what they’ve done is not too effective, he said.
With Danbio, the Danish registry, there’s an annual meeting held for every annual Danbio report that’s issued. “In the first year, in 2005, this public meeting caused substantial anxiety,” Dr. Dixon said. “But since then, everyone has viewed it favorably, and the meeting is always seen as very fruitful, with exchange of experience across the country.”
Building better systems and tools for benchmarking is a worthwhile endeavor. “We need to build and invest in infrastructure that facilitates real-time data extraction,” he said.
It will also be important to keep the patient perspective in mind. “We should also think about feedback to patients and what should be presented there,” he said. “What’s benchmarking from their point of view?”
Improving Care
In another talk on improving care in a systematic way, Tore K. Kvien, MD, professor of rheumatology at the University of Oslo, said that guidelines and recommendations seem to be leading to better care, at least in some areas, but it’s clear that clinicians don’t automatically adjust their care for the better simply because of official recommendations.
“We can know about recommendations … but whether we are really applying them in clinical practice, that is something different—and that is the most important thing,” Dr. Kvien said.
A study on physician compliance with EULAR recommendations on RA management—such as early start on disease-modifying drugs and monitoring of treat-to-target goals—found that doctors tend to say they comply more often than they actually do.1 Example: 98% of physicians said they were committed to the recommendation on early DMARD use, but this treatment was actually done only 67% of the time, according to a review of records. And 83% of physicians said they were committed to monitoring treat-to-target progress, but this approach was actually done only 27% of the time.
Nonetheless, patterns have improved in some areas following the issuing of recommendations, including the use of MTX at the right time, Dr. Kvien said. Other areas, such as management of gout, need much improvement.
