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| Topic | Indicator | Source |
Resources |
| History and exam |
1. If a patient has a confirmed diagnosis of rheumatoid arthritis, THEN
a measure of each of the following should be documented within 3
months of diagnosis and at least annually thereafter: joint exam,
functional status assessment, acute phase reactant, measurement of
pain, physician global assessment and patient global assessment.
| AFQuIP†, BSR/RCP | Helpful Hints |
| Treatment |
2. IF a patient has an established diagnosis of rheumatoid arthritis,
THEN the patient should be treated with a DMARD unless
contraindication to DMARD, inactive disease or patient refusal is
documented.
| NCQA/HEDIS, AFQuIP†, BSR/RCP |
Helpful Hints |
| 3. IF a patient has rheumatoid arthritis and is being treated with a
DMARD and there is evidence of increased disease activity or there
is evidence of progression of RA bony damage over a 6-month period
of time, THEN one of the following should be done: change
DMARD dose or route of administration, change DMARD, add an
additional DMARD, start or increase dose of glucocorticoids or
provide local glucocorticoid injection(s), unless the patient refuses or
all of the above are contraindicated.
| AFQuIP† |
Helpful Hints |
* DMARD = disease modifying antirheumatic drug, including abatacept, adalimumab, anakinra, azathioprine, cyclophosphamide, cyclosporine, etanercept, gold (oral or intramuscular), hydroxychloroquine, infliximab, leflunomide, methotrexate, penicillamine and sulfasalazine.
† AFQuIP = Arthritis Foundation Quality Indicator Project,
BSR/RCP = British Society for Rheumatology/ Royal College of Physicians,
NCQA/HEDIS = National Committee for Quality Assurance/ Health Employer Data and Information Set.
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| Topic | Indicator | Source |
Resources |
| Informing patients about risks |
1. IF a patient is newly prescribed any of the following drugs: NSAIDs
(selective or non-selective), DMARDs, glucocorticoids or narcotics,
THEN a discussion with the patient about the risks of the chosen
therapy should be documented.
| AFQuIP† |
Helpful Hints |
| Prophylaxis for patients at risk for gastrointestinal bleeding |
2. IF a patient is treated with 1) a non-selective NSAID or 2) a COX-2
selective NSAID plus aspirin, AND the patient has risk factors for
upper gastrointestinal bleeding‡, THEN the patient should be treated
concomitantly with either misoprostol or a proton pump inhibitor
unless patient refuses.
| AFQuIP†, ACOVE |
Helpful Hints |
| Lab monitoring |
3. IF a patient is treated with daily NSAIDs (selective or non-selective)
and the patient has risk factors for gastrointestinal bleeding‡ THEN
a hemoglobin or hematocrit should be performed at baseline and
during the first year after initiating therapy.
| AFQuIP† |
Helpful Hints |
| 4. IF a patient is treated with daily NSAIDs (selective or non-selective)
AND the patient has risk factors for developing renal
insufficiency** THEN a serum creatinine should be assessed at
baseline, within the first 3 months, and then at least annually
thereafter.
| AFQuIP† |
Helpful Hints |
| 5. IF a patient with rheumatoid arthritis is newly prescribed a DMARD,
THEN appropriate baseline studies should be documented within an
appropriate period of time from the original prescription.
(SEE
Table 1)
| AFQuIP† |
Helpful Hints |
| 6. IF a patient has established treatment with a DMARD or
glucocorticoids, THEN monitoring for drug toxicity should be
performed.
(SEE Table 2)
| AFQuIP† |
Helpful Hints |
*NSAID = non-steroidal anti-inflammatory drug
† AFQuIP = Arthritis Foundation Quality Indicator Project,
ACOVE = Assessing Care for Vulnerable Elders
‡ Risk factors for gastrointestinal bleeding are defined as any of the following: age ~ 75, peptic ulcer disease, gastrointestinal bleeding, or glucocorticoid use.
** Risk factors for renal insufficiency defined as any of the following: age ~ 75, diabetes mellitus, hypertension, angiotensin converting enzyme (ACE) inhibitor use or diuretic use.
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