Rheumatology Practices Need Sharp Focus on Patient Care Safety, Quality

For example, between February 2009 and January 2015, vaccination rates for pneumococcal vaccinations increased from 50% to 87% following implementation of the paper-based reminder intervention.³ Dr. Desai attributes this positive change to two important steps—integrating routine workflow and sharing performance data—which, when implemented together, effectively engaged specialists and staff in vaccine adherence improvement.

“There was concern at the beginning of this project about how workflow could be negatively impacted by the additional time required for this intervention, particularly for nurses. However, once we tested the intervention within the clinical workflow and shared the initial data with our team, we all understood how this improvement could be successfully implemented for measured improvement,” Dr. Desai explains.

She says taking this paper-based intervention to electronic form will be a new challenge, but it also provides new opportunities, such as a patient-facing component to help track patient information, educate patients and involve them in their own care.

Share the Data

Jinoos Yazdany, MD, MPH

Collecting and sharing data on quality improve­ment research around vaccinations has also been an area of focus for Jinoos Yazdany, MD, MPH, associate professor in the Division of Rheumatology, and associate clinical co-director of the Lupus Clinic at the University of California San Francisco (UCSF). She has focused much of her work on researching quality measures to improve care for patients with rheumatic diseases.

One of her roles is chair of the ACR’s RISE (Rheumatology Informatics System for Effectiveness) Registry Research & Publications Subcommittee, which manages access to aggregate, de-identified patient data, including outcomes data on patient safety measures, such as tuberculosis screening prior to starting high-risk biological medications.

“RISE aims to decrease the burden of data collection on practices, to streamline participation in federal quality programs and to facilitate local rapid-cycle quality improvement by providing continuous performance feedback and benchmarking,” wrote Dr. Yazdany and her colleagues in their analysis in Arthritis Care & Research, December 2016.

RISE works by automatically collecting data from a participating practice’s EHR system and transferring it to a secure central data warehouse. The system is compatible with about 30 different EHR programs and eliminates data entry for practices. Through an online dashboard, providers can see analytics of their performance on quality measures as compared to national benchmarks and the overall performance of providers participating in RISE. They can also run customized queries on their own patient population and perform basic data analyses.

Locally, Dr. Yazdany is also leading research on the performance of quality measures in patient populations at UCSF. For example, one study she co-authored evaluated reasons that immunosuppressed patients with systemic lupus erythematosus did not receive pneumococcal and influenza vaccinations. Study results suggested the most common reason (87%) these patients failed to receive pneumococcal and influenza vaccinations was because physicians didn’t recommend them.⁴