Quality measurement and improvement in rheumatology: Rheumatoid arthritis as a case study

In recent years, we have seen significant efforts to understand health care quality in the United States, including rheumatic diseases. Health care reform, as demonstrated through the Affordable Care Act (ACA) and Health Information Technology for Economic and Clinical Health (HITECH) Act, has further accelerated this rapidly evolving field. (1) The formidable tasks of improving quality, enhancing equity, and ensuring value in U.S. health care, remain largely unsolved. Rheumatologists are affected by programs aimed at driving quality improvement, including performance measurement, public reporting, and tiered payment systems. Many of these programs have focused on rheumatoid arthritis (RA), a condition with rising prevalence and increasing health care costs. In this paper, we review the literature regarding quality measurement and improvement in RA with four aims: 1) to define quality in RA, 2) to delineate the history of RA quality indicator/ measure development, 3) to outline lessons learned from prior RA quality measurement experiences, and 4) to frame the future of RA quality initiatives. In reviewing this literature, we strive to highlight both the achievements and failures in developing and implementing quality measures for RA.