Improved Gout Outcomes in Primary Care Using a Novel Disease Management Program: A Pilot Study

• Published in: Arthritis care & research (2010) 2018-11, Vol.70 (11), p.1679-1685
• Main Authors: Bulbin, David, Denio, Alfred E., Berger, Andrea, Brown, Jason, Maynard, Carson, Sharma, Tarun, Kirchner, H. Lester, Ayoub, William T.
• Format: Article
• Language: English
• Subjects: Disease management; Electronic medical records; Gout; Primary care; Uric acid
• ISSN: 2151-464X; 2151-4658
• DOI: 10.1002/acr.23544

Objective To pilot a primary care gout management improvement intervention. Methods Two large primary care sites were selected: 1 underwent the intervention, the other, a control, underwent no intervention. The intervention consisted of engagement of intervention‐site staff, surveys of provider performance improvement preferences, and onsite live and enduring online education. Electronic health record reminders were constructed. Both the intervention and control sites had 3 quality measures assessed monthly: the percentage of gout patients treated with urate‐lowering therapy, the percentage of treated patients monitored with serum urate, and the percentage of treated patients at target serum urate ≤6.0 mg/dl. The intervention‐site providers received monthly reports comparing their measures against their peers. Results By 6 months, the intervention site significantly improved all 3 gout performance measures. The percentage treated increased from 54.4% to 61.1% (odds ratio [OR] 1.19 [95% confidence interval (95% CI) 1.08–1.31]; P < 0.001), the percentage monitored increased from 56.1% to 79.2% (OR 1.52 [95% CI 1.24–1.87]; P < 0.001), and the percentage at goal increased from 26.85% to 43.3% (OR 1.43 [95% CI 1.16–1.77]; P < 0.001). At 6 months after intervention, gout patients at the intervention site were more likely to be monitored (79.2% versus 53.4% [OR 3.54 (95% CI 2.30–5.45)]; P < 0.001) and at goal (43.3% versus 28.3% [OR 1.99 (95% CI 1.33–2.96)]; P < 0.001) than control‐site patients. Numbers treated did not significantly improve over the control site. Conclusion A pilot multifaceted gout management program can significantly improve primary care gout management performance.