What Factors Are Associated With Quality Care Among Patients With RA?

The factors associated with quality care in patients with rheumatoid arthritis (RA) were studied and the findings published in JAMA Network Open. Insurance status, income, and medical comorbidities were found to be some of the strongest predictors of quality care among adults with RA.

Researchers used insurance claims data from the IBM Truven MarketScan Research Database from 2009 through 2017. Adult patients with a diagnostic code for RA were eligible for inclusion in the study.

Six markers by the Arthritis Foundation were used to assess patient care quality, including referral to a rheumatologist; hepatitis B screening prior to the initiation of disease-modifying antirheumatic drugs (DMARDs); baseline hand radiographs within 1 year of the initial visit; annual physical examination; annual laboratory testing; and referral for physical therapy, occupational therapy, or hand surgery. The status of achieving each marker was assessed at 1 year post-RA diagnosis.

The study cohort included 581,770 patients with a mean age of 48.9±11.3 years; 74.1% were women. The majority (84.3%) of patients reported an annual income greater than $45,200 and 40.6% resided in the southern part of the US. A total of 399,862 patients (68.7%) met at least 1 quality care marker, while 181,908 patients (31.3%) did not. Of the selected care markers, the most frequently achieved were referral to a rheumatologist (44.1%) and annual laboratory testing (51.5%); the remaining care markers were achieved by fewer than 10% of patients each. Further, 32.5% of patients had received a DMARD prescription within 1 year of diagnosis.

According to regression models, rheumatologist referral and DMARD treatments were strongly associated with meeting other quality care markers. Overall, men vs women were less likely to meet quality care markers.

Insurance status also had a predictive role, ie, noncomprehensive vs comprehensive insurance was associated with greater odds of receiving a rheumatologist referral, a hepatitis B screening, an annual physical examination, and annual laboratory testing. Medicare insurance was associated with lower odds of meeting all care markers, except hand radiographs or a referral for physical therapy, occupational therapy, or hand surgery.

Compared with patients with RA only, patients with comorbid medical conditions were less likely to receive a rheumatologist referral, hand radiographs, or an annual physical examination. Finally, patients with a lower vs higher median household income also had lower odds of receiving a rheumatologist referral, an annual physical examination, and annual laboratory testing.

Overall, the quality of care for patients with RA was found to vary widely and was associated with various demographic and clinical characteristics.

Limitations included the use of claims data, which may have introduced a sampling bias because patients without insurance were excluded from the study.

“These findings suggest that prioritizing early care, especially for vulnerable patients, will ensure that quality care continues,” the study authors wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of author’s disclosures.