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CRA Guidelines for the Management of Rheumatoid Arthritis- Update

CRA Guidelines for the Management of Rheumatoid Arthritis- Update. May 25, 2013. Pooneh Akhavan , MD . Learning Objectives. 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.

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CRA Guidelines for the Management of Rheumatoid Arthritis- Update

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  1. CRA Guidelines for the Management of Rheumatoid Arthritis- Update May 25, 2013 PoonehAkhavan, MD

  2. Learning Objectives 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

  3. Disclosures CRA recommendations were supported by the CIHR and matched funds from the CRA

  4. CRA Recommendations for RA ManagementJ Rheum 2012

  5. CRA Recommendations for RA 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)

  6. CRA Annual Meeting 2013- Ottawa Have you read the recommendations? Yes, read Part I: Treatment Yes, read Part II: Safety Yes, read both parts I and II No

  7. Presentation Outline Dissemination activities Moving towards the Quality Indicators

  8. Dissemination

  9. Overview Dissemination Activities Completed Publications (open access J Rheum / CRA website) Presentations (Local, regional, national international) Additional tools for download (CRA website) CRA guideline self-evaluation survey followed by CRAJ question and answer series (Summer 2013) In progress MDbriefcase eRecommendation program (CME accredited) EMR integration In future Multi-disciplinary RA guideline dissemination workshop September 2013

  10. 1. Dissemination Activities-Completed http://rheum.ca/en/publications/cra_ra_guidelines Download RA guideline documents Download RA algorithms & slide decks

  11. 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)

  12. 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)

  13. Dissemination Activities- In Progress 1. MDbriefcaseeRommendation program (will be CME accredited) • TREATMENT ASPECTS • SAFETY ASPECTS

  14. Dissemination Activities- In Progress • 2. Ongoing discussions with eHealth Ontario • -EMR Integration of selected key recommendations to measure performance

  15. Dissemination Activities- In Future September 2013 Interdisciplinary Dissemination and Local Adaptation Workshop (RA Guidelines) 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

  16. Overview Dissemination Activities Completed Publications (open access J Rheum / CRA website) Presentations (Local, regional, national international) Additional tools for download (CRA website) CRA guideline self-evaluation survey followed by CRAJ question and answer series (Summer 2013) In progress MDbriefcase eRecommendation program (CME accredited) EMR integration In future Multi-disciplinary RA guideline dissemination workshop September 2013

  17. Presentation Outline Dissemination activities Moving towards the Quality Indicators

  18. Development of Canadian Quality of Care Indicators for RA

  19. Developing QIs Clinical Practice Guidelines Define the optimal standard of care Quality Indicators Define the minimally acceptable standard of care

  20. 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 care • Example: “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”

  21. 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 DMARD • Denominator 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

  22. Evolution of Quality of RA Care Rheumatoid Arthritis Guidelines

  23. Evolution of Quality of RA Care Rheumatoid Arthritis Guidelines Rheumatoid arthritis quality measurement & Improvement

  24. Canadian QIs- In progress From RA Guidelines to QIs • Assessment of Disease Activity • Assessment of Functional Status • TB testing • Treatment with DMARDs • Administration of influenza vaccine • Administration of pneumococcal vaccine • CBC, Cr and LFT check ACR 2012 RA QIs To develop evidence- and consensus-based quality indicators for the care of Canadian adults living with RA using current CRA guidelines

  25. RA Guidelines Working Group Acknowledgment Dr. PoonehAkhavan Dr. Vivian Bykerk Dr. Claire Bombardier Mrs. Anne Dooley Dr. Paul Haraoui Dr. Glen Hazlewood Dr. MajedKhraish Dr. Sharon LeClercq Mr. Jean Légaré Dr. Diane Mosher Dr. James Pencharz Dr. Janet Pope Ms. Orit Schieir Dr. John Thomson Dr. Carter Thorne Dr. Michel Zummer For any queries/ comments about CRA recommendations for RA, please contact raguidelines@rheum.ca CRA On-line Survey Dr. Sanjay Dixit

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