Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs

Brady, Brenna L.; Tkacz, Joseph; Meyer, Richard W.; Bolge, S.; Ruetsch, Charles

doi:10.1089/pop.2015.0133

Cited by 7 publications

(8 citation statements)

References 31 publications

(42 reference statements)

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“…This was a retrospective analysis of medical and pharmacy claims data from the OLDW, a large national administrative claims database that includes longitudinal health data of more than 100 million individuals enrolled in private and Medicare Advantage health plans since 1994, which offers an excellent platform to trend the cost of care and private health insurance. The population is diversely distributed in age, race, and geographical location in all 50 states.…”

Section: Methodsmentioning

confidence: 99%

Healthcare Cost and Utilization in Nonalcoholic Fatty Liver Disease: Real‐World Data From a Large U.S. Claims Database

Allen¹,

et al. 2018

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The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing. The health care burden resulting from the multidisciplinary management of this complex disease is unknown. We assessed the total health care cost and resource utilization associated with a new NAFLD diagnosis, compared with controls with similar comorbidities. We used OptumLabs Data Warehouse, a large national administrative claims database with longitudinal health data of over 100 million individuals enrolled in private and Medicare Advantage health plans. We identified 152,064 adults with a first claim for NAFLD between 2010 and 2014, of which 108,420 were matched 1:1 by age, sex, metabolic comorbidities, length of follow-up, year of diagnosis, race, geographic region, and insurance type to non-NAFLD contemporary controls from the OptumLabs Data Warehouse database. Median follow-up time was 2.6 (range 1-6.5) years. The final study cohort consisted of 216,840 people with median age 55 (range 18-86) years, 53% female, 78% white. The total annual cost of care per NAFLD patient with private insurance was $7,804 (interquartile range [IQR] $3,068-$18,688) for a new diagnosis and $3,789 (IQR $1,176-$10,539) for long-term management. These costs are significantly higher than the total annual costs of $2,298 (IQR $681-$6,580) per matched control with similar metabolic comorbidities but without NAFLD. The largest increases in health care utilization that may account for the increased costs in NAFLD compared with controls are represented by liver biopsies (relative risk [RR] = 55.00, 95% confidence interval [CI] 24.48-123.59), imaging (RR = 3.95, 95% CI 3.77-4.15), and hospitalizations (RR = 1.87, 95% CI 1.73-2.02). Conclusion: The costs associated with the care for NAFLD independent of its metabolic comorbidities are very high, especially at first diagnosis. Research efforts shouldfocus on identification of underlying determinants of use, sources of excess cost, and development of cost-effective diagnostic tests.

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Section: Methodsmentioning

confidence: 99%

Healthcare Cost and Utilization in Nonalcoholic Fatty Liver Disease: Real‐World Data From a Large U.S. Claims Database

Allen¹,

et al. 2018

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“… 17 30–32 A recent population-based analysis measured a set of quality indicators of the pharmacological management of RA, correlating the adherence to HCQIs with health expenditure. 16 This study analysed separately eight indicators (one of which was related to the ESR and CRP monitoring at 3 months in the newly diagnosed RA), finding an increase in drug-related expenditures in the groups of patients who met the indicator, along with a reduction in the cost of hospital services. This study suggested the sustainability of the implementation of treatment standards at the population level.…”

Section: Discussionmentioning

confidence: 99%

“…These real-world data reflect at system level what has already been established in clinical studies on limited and selected subjects. 16 17 The choice of hospitalisation as the main outcome measure is linked to its relevance both for the individual health and for its impact on the healthcare system. 18 Furthermore, early hospitalisation (within the first 2 years from RA onset) is a measure of failure of the RA care pathway and represents one of the most important mortality risk factors after age and persistent disease activity.…”

Section: Discussionmentioning

confidence: 99%

“…Another study assessed the influence of ESR or CRP monitoring within 3 months by the diagnosis on healthcare expenditures. 18 Brady et al 16 found lower costs associated to inpatient services in patients with acute phase reactant monitoring. A possible explanation of this discrepancy might rely on the stringency of our indicators.…”

Section: Open Accessmentioning

confidence: 99%

“…A recent analysis, using administrative claims in the USA, showed that individual fulfilment of quality standards of treatment and monitoring of disease activity and DMARD toxicity is associated with lower hospital costs. 16 Non-adherence to DMARDs in early RA was investigated as an HCQI with potential impact on healthcare systems. A Dutch study analysed data from about 200 patients with early RA, showing that suboptimal drug adherence is associated with higher overall costs, with a +10% expenditure due to hospitalisation.…”

Section: Introductionmentioning

confidence: 99%

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Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology

et al. 2020

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ObjectiveTo describe the adherence to quality of care indicators in early rheumatoid arthritis (RA) and to evaluate its impact on the risk of hospitalisation in a real-world setting.DesignRetrospective cohort study.SettingPatients with early-onset RA identified from healthcare regional administrative databases by means of a validated algorithm between 2006 and 2012 in the Lombardy region (Italy).ParticipantsThe study cohort included 14 203 early-onset RA (71% female, mean age 60 years).Outcome measuresFor each patient, a summary adherence score was calculated starting from the compliance to six quality indicators: (1–2) methotrexate or sulfasalazine or leflunomide with/without glucocorticoids, (3–4) other disease-modifying antirheumatic drugs (DMARDs) with/without glucocorticoids, (5) early interruption of glucocorticoids, (6) early clinical assessment.The relationship between low, intermediate and high categories of the summary score and the 12-month risk of hospitalisation for all causes and for RA was assessed.ResultsDuring a follow-up of 1 year, 2609 hospitalisations occurred, of which 704 were for RA (main or secondary diagnosis) and 252 primarily for RA. In a 7-year period (2006–2012), early DMARDs and timely clinical monitoring treatment increased (from 52% to 62% p trend <0.001 and from 25% to 30% p trend 0.009, respectively).Intermediate and high summary adherence score categories (compared with the low category) were related significantly with a lower risk of hospitalisation (adjusted HR 0.85 (95% CI 0.77 to 0.93), p<0.001 and HR 0.76 (95% CI 0.69 to 0.84), p<0.001, respectively). Among the indicators of the adherence score, early DMARD prescription showed the strongest positive impact, while long-term use of glucocorticoids was the worst negative one.ConclusionIn early RA, adherence to quality standards of care is associated with a lower risk of hospitalisation. Future interventions to improve the adherence to quality standards of care in this setting should decrease the risk of hospitalisation with a significant impact on individual and population health.

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Ambulatory Medication Safety: Vaccination and Laboratory Screening for Patients Receiving Immunomodulatory Therapies

McDonnell

Iversen

Khinkar

et al. 2022

Arthritis Care & Research

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Objective. Immunomodulatory therapies improve the management of chronic diseases but can be associated with infectious risk. The present study was undertaken to examine the laboratory screening practices for hepatitis B virus (HBV), hepatitis C virus (HCV), and tuberculosis (TB) and rates of vaccination for pneumococcal and influenza in patients prescribed select immunosuppressive agents at our institution.Methods. A retrospective analysis was conducted to review patients who were prescribed a select immunosuppressive over 3 years. Data were extracted from electronic health records to identify rates of screening and vaccination prior to initiation or at any time. Logistic regression models were developed to identify predictors of screening and vaccination.Results. We identified 2,396 patients prescribed immunosuppressive medications by rheumatology (52.6%) and non-rheumatology specialties. Rates of screening at any time point were 84.5% (2,025 of 2,396) for HBV, 76.7% (1,838 of 2,396) for HCV, and 71.8% (1,720 of 2,396) for TB. Patients who had either in-system primary care providers (PCPs) or rheumatologists were more likely to receive pneumococcal vaccinations (odds ratio [OR] 1.98 [95% confidence interval (95% CI) 1.55-2.54] and OR 4.08 [95% CI 2.76-6.02], respectively). Patients with dermatologic (OR 1.67 [95% CI 1.14-2.45]) or rheumatologic providers (OR 2.5 [95% CI 1.86-3.36]) were more likely to be vaccinated for influenza.Conclusion. More than 70% of patients were screened for either HBV, HCV, or TB at some point. Rates of pneumococcal vaccination were better than rates of influenza vaccination. Patients with in-system PCPs were more likely to be screened and vaccinated. Establishing and executing consistent processes for screening and vaccination prior to immunosuppressive treatment remains a priority in ambulatory settings.

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Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs

Cited by 7 publications

References 31 publications

Healthcare Cost and Utilization in Nonalcoholic Fatty Liver Disease: Real‐World Data From a Large U.S. Claims Database

Healthcare Cost and Utilization in Nonalcoholic Fatty Liver Disease: Real‐World Data From a Large U.S. Claims Database

Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology

Ambulatory Medication Safety: Vaccination and Laboratory Screening for Patients Receiving Immunomodulatory Therapies

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