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National Center for Chronic Disease Prevention and Health Promotion
Division of Adult and Community Health
Health Care and Aging Studies Branch
Arthritis Program
Mailstop K-51
4770 Buford Highway NE
Atlanta, GA 30341-3724
Phone: 770.488.5464
Fax: 770.488.5964
Email Us |
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CDC-Funded Science
A Systems Approach to Improving Arthritis Clinical Care
Funding Number
200-95-0953-050/ MC2-18
Project Description
The current health care delivery system, developed when acute
illnesses were the most prominent health problems, is not well suited to
meet the needs of individuals with chronic diseases such as arthritis.
Systematic changes in health care delivery are required to meet the
challenges of chronic disease management. The ultimate purpose of this
contract was to pilot test a systems approach for improving the quality
of arthritis clinical care. To support this systems approach, it was
necessary to develop an algorithm that could be used to identify people
with arthritis from automated health plan data systems, and to develop a
method health organizations could use to estimate the size of their
“arthritis problem”. The contract consisted of three components:
- Develop a patient algorithm to identify within administrative
data systems individuals with arthritis and the subset of
individuals appropriate to receive standardized care.
- Identify methods to define arthritis costs by estimating service
use; such as, physician visits, hospitalizations, radiology,
pharmaceuticals, and other related costs.
- Organize and facilitate a structured arthritis clinical care
quality improvement initiative in partnership with one or two
CDC-funded core arthritis programs in state health departments.
Key Findings:
Objective 1: Case finding method for populating clinical
management registries
- The automated data case-finding algorithm (defined as two
ICD-9 codes recorded in the administrative data system) worked
well to identify persons with a diagnosis of rheumatoid
arthritis (as identified in the paper medical record). The same
algorithm worked reasonably well for osteoarthritis and gout,
and did not work well for fibromyalgia. More complex algorithms
using arthritis-related laboratory test results and medication
records did not substantially improve case finding via automated
data systems.
- Rheumatoid arthritis is easily identified using ICD-9 data
and can be readily used to populate population-based clinical
management registries. Persons with a diagnosis of gout and
osteoarthritis can be identified using automated data but a
significant proportion of individuals will be missed and 18-22%
will not actually have the condition. Fibromyalgia is poorly
identified using automated data.
Objective 2: Defining arthritis-related costs by estimated
service use from MCO records
- Organization-specific methods to make cost estimations from
service use is challenging.
Objective 3: Pilot testing a systems approach to clinical
quality improvement
- 67% of the professionals participating in the Improving
Arthritis Clinical Care Collaborative I reported that they
changed the way they treated patients with OA. The reported
using tools such as planned or group visits, proactive
follow-up, referrals to exercise or education programs, and
routine assessment of pain and disability.
- Organizational challenges to quality improvement in
arthritis included time constraints and competing demands, staff
turn-over, lack of support from senior leadership, and lack of
physician enthusiasm.
- Arthritis-specific challenges to quality improvement efforts
included absence of clear clinical indicators of improvement
(“there is no hemoglobin A1C for arthritis”), the subjective
nature of pain and disability, and difficulty engaging patients
who perceived other health problems as more pressing.
- Professionals participating in Collaborative II, which
focused specifically on self management of osteoarthritis among
patients with symptomatic OA, made similar changes in their
practice and did not experience difficulties engaging OA
patients with limitations to participate in the improvement
efforts; in contrast, patients were “delighted’ that their OA
was being seriously addressed.
List any the abstracts, publications, presentations:
Manuscript in preparation
Principal Investigator:
Ed Wagner, MD, MPH
MacColl Institute for Health Care Innovation
Group Health Cooperative of Puget Sound
1730 Minor Ave, suite 1290
Seattle WA 98101
CDC Arthritis Program Contact:
Teresa J. Brady, PhD
Last updated: September 2006
Back to Funded Science
Page last reviewed: June 4, 2008
Page last modified: September 18, 2006
Content Source: Division of
Adult and Community Health,
National Center for Chronic Disease Prevention and Health Promotion
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