RT Journal Article SR Electronic T1 Using Process Improvement and Systems Redesign to Improve Rheumatology Care Quality in a Safety Net Clinic JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP jrheum.190472 DO 10.3899/jrheum.190472 A1 Alfredo Aguirre A1 Laura Trupin A1 Mary Margaretten A1 Sarah Goglin A1 Jung Hee Noh A1 Jinoos Yazdany YR 2020 UL http://www.jrheum.org/content/early/2020/08/24/jrheum.190472.abstract AB Objective To develop and evaluate interventions to improve quality of care in 4 priority areas in an urban safety net adult rheumatology clinic serving a racially/ethnically and socioeconomically diverse patient population. Methods The Institute for Healthcare Improvement’s Model for Improvement was used to redesign clinical processes to achieve prespecified benchmarks in the following areas from 2015 to 2017: 13-valent pneumococcal conjugate vaccine (PCV13) administration among immunocompromised patients; disease activity monitoring with the Clinical Disease Activity Index (CDAI) for patients with rheumatoid arthritis; latent tuberculosis infection (LTBI) screening for new biologic users with RA; and reproductive health counseling among women receiving potentially teratogenic medications. We measured performance for each using standardized metrics, defined as the proportion of eligible patients receiving recommended care. Results There were 1205 patients seen in the clinic between 2015 and 2017. Regarding demographics, 71% were women, 88% identified as racial/ethnic minorities, and 45% were eligible for at least 1 of the quality measures. Shewart charts for the PCV13 and CDAI measures showed evidence of improved healthcare delivery over time. Benchmarks were achieved for the CDAI and LTBI measures with 93% and 91% performance, respectively. Performance for the PCV13 and reproductive health counseling measures was 78% and 46%, respectively, but did not meet prespecified improvement targets. Conclusion Through an interprofessional approach, we were able to achieve durable improvements in key rheumatology quality measures largely by enhancing workflow, engaging nonphysician providers, and managing practice variation.