Nearly a Third of Patients Met No Markers of Quality Care a Year After RA Diagnosis

Patients who were male, insured by Medicare, or with comorbidities tended to be less likely to meet quality care markers 1 year after rheumatoid arthritis (RA) diagnosis, according to study results published online in JAMA Network Open.

“Although this study is based on a hypothetical care model, it supports prior research that has found variable quality of RA care and indicates specific patient populations that can be targeted for improvement,” wrote study corresponding author Kevin C. Chung, MD, of the University of Michigan Health System in Ann Arbor, and coauthors.

The retrospective study used insurance claims data to investigate the prevalence of meeting successive Arthritis Foundation quality markers 1 year after RA diagnosis in 581,770 patients. The 6 quality care measures included were: (1) referral to a rheumatologist; (2) hepatitis B screening prior to disease-modifying antirheumatic drug (DMARD) initiation; (3) baseline hand radiographs; (4) annual physical examination; (5) annual laboratory testing; and (6) physical therapy, occupational therapy, or hand surgery referral.

Some 399,862 patients (68.7%) met at least 1 quality care marker, according to the study, while 181,908 (31.3%) met no markers.

Annual laboratory testing (51.5%) and referral to a rheumatologist (44.1%) were the markers patients met most often. Hepatitis B screening prior to DMARD initiation (3.2%) was the least met marker. With the exception of hepatitis B screening before starting DMARDs, women had greater odds of meeting all quality care markers, researchers reported.

The study also identified an association between receiving a rheumatologist referral and DMARDs with meeting additional downstream quality measures.

“Notable variation existed among demographic characteristics associated with achieving quality care measures,” researchers wrote. “In addition, only 27 patients of the 581,770 included in the cohort met all care markers; there is an urgent need to improve the progression of care for patients with RA.”

—Jolynn Tumolo

Reference

Seyferth AV, Cichocki MN, Wang CW, et al. Factors associated with quality care among adults with rheumatoid arthritis. JAMA Netw Open. Published online December 12, 2022. doi:10.1001/jamanetworkopen.2022.46299