Percentage of patients aged 18 years and older with a diagnosis of rheumatoid arthritis (RA) who have been assessed for glucocorticoid use and, for those on prolonged doses of prednisone >= 10 mg daily (or equivalent) with improvement or no change in disease activity, documentation of glucocorticoid management plan within 12 months.
ACP does not support QPP measure 180: “Rheumatoid Arthritis: Glucocorticoid Management.” The developers did not provide adequate information for us to meaningfully evaluate the validity of this measure. Although we recognize the importance of managing the lowest effective dose of glucocorticoids and using alternative therapies when possible, both the numerator and the denominator are poorly specified. The measure specifications do not include appropriate exclusions for patients prescribed prednisone therapy for a symptomatic flare. A cleaner measure may specify “patients with rheumatoid arthritis (RA) who are on glucocorticoids” in the denominator statement. Additionally, the current American College of Rheumatology (ACR) clinical guidelines demonstrate the importance of assessing glucocorticoid use, but only in patients who have specifically been prescribed glucocorticoid therapy.