eMeasure Title	Disease Activity Measurement for Patients with RA
eMeasure Identifier (Measure Authoring Tool)	214	eMeasure Version number	0
NQF Number	Not Applicable	GUID	2731ead9-8437-4fd0-9135-1c71c48b4ef4
Measurement Period	January 1, 20xx through December 31, 20xx
Measure Steward	American College of Rheumatology
Measure Developer	American College of Rheumatology
Endorsed By	None
Description	If a patient has rheumatoid arthritis, then disease activity using a standardized measurement tool should be assessed at >=50% of encounters for RA.
Copyright
Disclaimer	CPT(R) contained in the Measure specifications is copyright 2004–2013 American Medical Association. LOINC(R) copyright 2004–2012 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004–2012 International Health Terminology Standards Development Organisation. ICD-10 copyright 2012 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring	Proportion
Measure Type	Process
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	Target low disease activity or remission. The panel recommends targeting either low disease activity (Table 3) or remission (Table 2) in all patients with early RA (Figure 1; level of evidence C) and established RA (Figure 2; level of evidence C) receiving any DMARD or biologic agent. (2012 guideline, page 631) The goal for each RA patient should be low disease activity or remission. In ideal circumstances, RA remission should be the target of therapy, but in others, low disease activity may be an acceptable target. But for other patients, the decision about what the target should be for each patient is appropriately left to the clinician caring for each RA patient, in the context of patient preferences, comorbidities, and other individual considerations. Therefore, this article does not recommend a specific target for all patients. (2012 RA guideline, page 637)
Clinical Recommendation Statement	In 2008, the American Medical Association’s Physician Consortium for Performance Improvement (AMA PCPI), the National Committee for Quality Assurance (NCQA) and the American College of Rheumatology (ACR) collaborated to develop a rheumatoid arthritis (RA) quality measure set for the Physical Quality Reporting System (PQRS), including a measure related to disease activity assessment. The measure assessed whether disease activity was assessed at least once per year and categorized as remission, low, moderate or high. The ACR subsequently developed a national registry platform, the Rheumatology Clinical Registry (RCR), to aid rheumatologists in reporting this PQRS measure. In 2012, performance on the measure was 54% among participating rheumatologists. Feedback from the rheumatology community and experts suggested potential ways to improve the measure (Desai S and Yazdany J. Arthritis Rheum. 2011 Dec;63(12):3649–60). The current e-measure builds on the experience of the last 6 years to add specificity and greater validity to disease activity assessment in RA (only validated and feasible measures are listed as acceptable, and the requirement for performing assessments has been increased to ≥50% or more of all RA encounters). These changes more closely align with ACR guidelines for measuring disease activity and “treating to target” in RA (Singh J, Arthritis Care Res. 2012 May;64(5):625–39) and Anderson J, Arthritis Care Res (Hoboken). 2012 May;64(5):640–7).
Improvement Notation	Higher score indicates better quality
Reference	Recommendation 1A in 2012 ACR RA guideline (Singh et al. AC&R, 2012)
Definition	For purposes of this measure, “Rheumatoid Arthritis Disease Activity Measurement Tools” include the following instruments: Clinical Disease Activity Index (CDAI) Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein) (DAS-28) Patient Activity Scale (PAS) Patient Activity Score-II (PAS-II) Routine Assessment of Patient Index Data with 3 measures (RAPID 3) Simplified Disease Activity Index (SDAI) A result of any kind qualifies for meeting numerator performance.
Guidance	One of the requirements for a patient to be included in the Initial Patient Population is that the patient has a minimum of 2 RA encounters with the same provider, all occurring during the measurement period. If the patient qualifies for the Initial Patient Population, then every encounter for RA should be evaluated to determine whether disease activity using a standardized measurement tool was assessed. The logic represented in this measure will determine if the patient had a disease activity assessment performed at each visit during the measurement period (i.e., Occurrence A of Encounter, Performed). The measure requires all of the eligible encounters to be analyzed in order to determine if the patient’s disease activity was assessed at >=50% of encounters for RA. Once it has been determined if the patient meets >=50% threshold, all patient data across a single physician should be aggregated to determine the performance rate.
Transmission Format	TBD
Initial Patient Population	Patients 18 years and older with a diagnosis of rheumatoid arthritis seen for two or more face-to-face encounters for RA with the same clinician during the measurement period
Denominator	Equals Initial Patient Population
Denominator Exclusions	None
Numerator	# of patients with >=50% of total number of outpatient RA encounters in the measurement year with assessment of disease activity using a standardized measure.
Numerator Exclusions	Not Applicable
Denominator Exceptions	None
Measure Population	Not Applicable
Measure Observations	Not Applicable
Supplemental Data Elements	For every patient evaluated by this measure also identify payer, race, ethnicity and sex.