Leveraging the Consolidated Framework for Implementation Research to Develop the American College of Rheumatology's Toolkit for Implementation of Rheumatoid Arthritis Outcome Measures in Clinical Practice: A Qualitative Study

Abstract

ObjectiveDespite the recognized benefits of collecting rheumatoid arthritis (RA) outcomes measures, their use in routine care is inconsistent. Using the Consolidated Framework for Implementation Research (CFIR), we conducted semistructured interviews with US rheumatologists and practice personnel to assess workflows, opportunities, and challenges in collecting RA outcome measures. Using insights from interviews, we developed the RA Measures Toolkit to enhance their use in clinical practice.MethodsWe invited 138 Rheumatology Informatics System for Effectiveness (RISE) registry practices and 5 academic medical centers with ≥30 patients eligible for RA outcome measures to participate in the study. Practices were classified based on their performance in quality payment programs. Recorded interviews were transcribed verbatim and analyzed thematically using deductive and inductive techniques. The findings were used to create the RA Measures Toolkit.ResultsWe conducted 20 interviews with 38 participants across 20 practices. Key themes within the CFIR domains highlighted the challenges and best practices in RA outcome measure collection and included (1) process: the variability in practices’ use of RA outcome measures and the importance of streamlined workflows; (2) intervention: challenges of integrating patient‐reported outcomes into electronic health records; and (3) individual characteristics: importance of clinic culture around quality improvement. Using these data, we developed the RA Measures Toolkit, a multimedia online resource, featuring guidelines, best practices, and educational resources to improve the efficiency of current workflows and to enhance patient care.ConclusionThis study identifies critical gaps in the collection of RA outcome measures in US rheumatology practices and provides actionable recommendations and resources to address challenges via the RA Measures Toolkit.