CRA Guidelines for the Management of Rheumatoid Arthritis- Update May 25, 2013 Pooneh Akhavan, MD.
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Transcript of CRA Guidelines for the Management of Rheumatoid Arthritis- Update May 25, 2013 Pooneh Akhavan, MD.
1- Describe the CRA's multi-faceted approach to disseminate the RA recommendations
2- Understand the process of moving from RA guidelines to RA Quality Indicators
2
Learning Objectives
Part 1: Treatment – 26 recommendations
• RA management strategies (6)• Glucocorticoids and traditional DMARDs (8)• Biologic DMARDs (12)
Part 2: RA drug safety – 13 recommendations
•Perioperative management (2)•Screening for LTBI prior to biologic therapy (4)•Optimal vaccination practices (3)•Treatment of RA patients with a history of malignancy (4)
CRA Recommendations for RA
1. Yes, read Part I: Treatment2. Yes, read Part II: Safety3. Yes, read both parts I and II4. No
Have you read the recommendations?
CRA Annual Meeting 2013- Ottawa
1 2 3 4
12%
43%44%
1%
Overview Dissemination Activities
Completed
1. Publications (open access J Rheum / CRA website)
2. Presentations (Local, regional, national international)
3. Additional tools for download (CRA website)
4. CRA guideline self-evaluation survey followed by CRAJ question and answer series (Summer 2013)
In progress
1. MDbriefcase eRecommendation program (CME accredited)
2. EMR integration
In future
Multi-disciplinary RA guideline dissemination workshop September 2013
1. Dissemination Activities-Completed
Download RA
guideline documents
Download RA
algorithms &
slide decks
http://rheum.ca/en/publications/cra_ra_guidelines
Dissemination Activities-Completed
2. Presentations at rheumatology meetings:• International: ACR, EULAR• National: CRA, PANLAR• Regional meetings: WAR, ORA, SOAR,
Laurentian• Various local meetings
3. Slide decks as self-teaching tools and/or for presentations at local rounds and other educational activities (www.rheum.ca/en/publications/cra_ra_guidelines)
Dissemination Activities- Completed
4. CRA self-evaluation survey:
- 24 questions
- CRA membership
- April-May 2013
- 188 of 432 responded
- CRAJ series (to start this Summer)
1. MDbriefcase eRommendation program (will be CME accredited)
Dissemination Activities- In Progress
TREATMENT ASPECTS
SAFETY ASPECTS
Dissemination Activities- In Progress
2. Ongoing discussions with eHealth Ontario- EMR Integration of selected key recommendations to measure performance
Dissemination Activities- In Future
• CIHR meeting grant approved
• Objectives:• a) Discuss barriers and local adaptation issues from
knowledge users (clinicians, therapists, pharmacists, nurses and patients)
• b) Create a plan for targeted messages for each knowledge user group
• c) Start the process of identifying the Quality Indicators from the guidelines
Interdisciplinary Dissemination and Local Adaptation
Workshop (RA Guidelines)
September 2013
Overview Dissemination Activities
Completed
1. Publications (open access J Rheum / CRA website)
2. Presentations (Local, regional, national international)
3. Additional tools for download (CRA website)
4. CRA guideline self-evaluation survey followed by CRAJ question and answer series (Summer 2013)
In progress
1. MDbriefcase eRecommendation program (CME accredited)
2. EMR integration
In future
Multi-disciplinary RA guideline dissemination workshop September 2013
Developing QIs
Define the optimal standard of
care
Define the minimally acceptable standard of care
Quality Indicators
Clinical Practice Guidelines
Definitions
Quality Measure
• Measures the performance • Has detailed specifications (numerator/denominator)
Number of eligible patients receiving a process of care (×100)Number of patients eligible for a process of careExample: “the percentage of patients age 18 and older who were prescribed, dispensed, or administered at least one ambulatory prescription for a DMARD during the 12-month reporting period”
Another Example: TB screening
Numerator• Patients with a TB screening within six months prior to
receiving a first course of a biologic DMARD
Denominator• Patients 18 years with RA and receiving a first
course of a biologic DMARDDenominator Exclusions• Medical reason for not screening for TB
– Patient positive for TB and documentation of past treatment
– Patient who has recently completed a course of anti-TB therapy
Evolution of Quality of RA Care
RHEUMATOID ARTHRITIS GUIDELINES
2000 2002 2004 2006 2008 2010 2012
2006 2008 2010 2012
RHEUMATOID ARTHRITIS QUALITY MEASUREMENT & IMPROVEMENT
From RA Guidelines to QIsACR 2012 RA QIs Canadian QIs- In progress
To develop evidence- and consensus-based quality indicators for the care of Canadian adults living with RA using current CRA guidelines
1. Assessment of Disease Activity
2. Assessment of Functional Status
3. TB testing4. Treatment with DMARDs5. Administration of influenza
vaccine6. Administration of
pneumococcal vaccine7. CBC, Cr and LFT check
For any queries/ comments about CRA recommendations for RA, please
Acknowledgment
Dr. Pooneh AkhavanDr. Vivian BykerkDr. Claire Bombardier Mrs. Anne DooleyDr. Paul Haraoui Dr. Glen Hazlewood Dr. Majed KhraishDr. Sharon LeClercq Mr. Jean LégaréDr. Diane Mosher Dr. James Pencharz Dr. Janet PopeMs. Orit SchieirDr. John ThomsonDr. Carter ThorneDr. Michel Zummer
RA Guidelines Working Group
CRA On-line SurveyCRA On-line Survey
Dr. Sanjay Dixit