Suboptimal EHR Reporting of Clinical Measures in RA Patients Receiving a Biologic or Targeted Synthetic DMARD

Current American College of Rheumatology treatment guidelines recommend a treat-to-target strategy based on various quantitative clinical end points, including validated disease severity measures. This retrospective analysis of the Optum One electronic health record (EHR) databases from various Integrated Delivery Networks (IDNs) and large group practices across the United States was conducted to examine the EHR reporting rates of several clinical measures among patients with rheumatoid arthritis (RA) who received a biologic or a targeted synthetic disease-modifying antirheumatic drug (tsDMARD).

Clinical measures assessed included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or tuberculosis (TB) test, and validated disease severity measures (Routine Assessment of Patient Index Data [RAPID3], Disease Activity Score [DAS28], or Clinical Disease Activity Index [CDAI]). Data from a total of 27 IDNs and 28 non-IDNs were included in this analysis. Patients (n = 29,829) included in the analysis were aged ≥18 years, had RA diagnoses ≥7 days apart between June 30, 2008, and July 31, 2015, and received ≥1 biologic or tsDMARDs indicated for RA treatment during the study period. The EHR reporting rates were presented for these clinical measures at baseline and follow-up. The 2 study cohorts evaluated included patients who switched from a tumor necrosis factor inhibitor (TNFi) to receive biologic or tsDMARDs (n = 7838), and those who received them without switching from a TNFi (n = 21,991).

The patient demographics were significantly different across the different IDN and non-IDN datasets. During the 1-year baseline period before the index date, among RA patients who switched from a TNFi or received a biologic or tsDMARD, the EHR reporting rate of a TB test was 18.8% and varied significantly across the 10 IDNs, from 9.1% to 44.6%. During the first year of follow-up after switching, postindex ESR and/or CRP EHR reporting rates were 49.0%, and varied across IDNs from 23.4% to 70.4%. During 1-year follow-up, only 6.5% of patients had EHR reporting of ≥1 disease severity measures (RAPID3, 5.8%; DAS28, 0.2%; CDAI, 0.6%), with significant variation across IDNs ranging from 0.0% to 25.2%.

Given the increasing thrust on a treat-to-target approach, the authors concluded that more consistent and complete EHR reporting is recommended to assist rheumatologists in decision-making in terms of assessing whether RA treatment targets are being achieved and making necessary modifications if needed.

Chastek B, et al. ACR 2017. Abstract 130.

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