Practices in ACR’s RISE registry report ‘doubled to tripled’ improvement in RA assessment
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WASHINGTON — Practices that join the American College of Rheumatology’s RISE registry report “doubled to tripled” rates of improvement in rheumatoid arthritis function and disease activity assessment, according to data.
Significant improvements were also reported in tuberculosis and osteoporosis screening.
“The ACR has made a huge investment in developing the RISE registry,” Gabriela Schmajuk, MD, chief of rheumatology at the San Francisco VA Health Care System, and a professor in the division of rheumatology at the University of California, San Francisco, told Healio. “We wanted to understand whether participation in the RISE registry yields benefits for practices and for patients in terms of performance on quality measures.”
The ACR’s Rheumatology Informatics System for Effectiveness (RISE) is an electronic health record-enabled registry that facilitates quality measure reporting to national pay-for-performance programs, according to Schmajuk, who presented the data ACR Convergence 2024.
To assess the practice-level impacts of joining RISE, Schmajuk and colleagues analyzed the performance of six rheumatology-specific quality measures for 339,745 patients among 81 practices that participated in the registry between 2015 and 2020. Practices were assessed from 12 months before enrollment through 24 months after.
“We used an Interrupted Time Series analysis to examine this question,” Schmajuk said. “The rationale was that when practices onboarded to the registry, historical data are uploaded that can be used to calculate quality measure performance before they joined RISE. Our hypothesis was that practice performance on quality measures would improve more rapidly after joining RISE compared to before.”
Measures that underwent evaluation included osteoporosis screening, RA functional status assessment, RA periodic disease activity assessment, tuberculosis screening, hepatitis B screening and RA low disease activity or remission.
In all, 60% of the practices included in the analysis were single specialty, while 36% used the EHR vendor Nextgen.
Results showed improvement in all six outcome measures after practices joined RISE, according to the researchers. The improvement typically began at 1 month and continued on an upward trajectory over subsequent months. The researchers reported linear increases ranging from 0.01 to 0.92 percentage points per month for the six outcome measures (P < .05). The largest increases were observed for RA periodic assessment of disease activity (0.78) and RA functional status assessment (0.92).
“We found that trends varied depending on the quality measure,” Schmajuk said. “For RA process measures, such as collection of functional status measures and disease activity scores, the rate of improvement doubled to tripled after joining RISE compared to before,” Schmajuk said. “For the other quality measures, we did not see such meaningful changes. We did observe that practices with lower baseline performance when they joined the registry seemed to improve more quickly on many of the measures.”
The exception to this data point regarding baseline levels was HBV screening, which demonstrated a flatter trajectory, according to the results.
“Our findings suggest that practices and patients benefit from joining RISE,” Schmajuk said. “The mechanism by which quality improves is not clear. It may be due to the financial incentives associated with MIPS reporting, which almost all RISE practices do. It may also be due to the tools provided through the RISE dashboard, which can help practices with their own quality improvement efforts.”
The group is conducting additional ongoing studies to answer these questions, according to Schmajuk.
“The other message is that practices participating in RISE have created one of the largest registries of RA patients with clinical outcomes in the world,” she said. “This is a huge accomplishment, since the data we have in RISE can be used for important research for clinical questions.”
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Schmajuk G. Abstract #1644. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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