DMARD Patient Safety Dashboard App
Last updated
Share PrintThe goal of the DMARD Patient Safety Dashboard App is to improve safe prescribing of DMARD medications. The DMARD Latent Infections Dashboard focuses on screening for latent infections (tuberculosis (TB), hepatitis B virus (HBV), and hepatitis C virus (HCV)) prior to starting new immunosuppressants, and the Hydroxychloroquine Dashboard focuses on weight-based dosing of hydroxychloroquine.
Recent Updates
Overview
The problem
The rapid proliferation of specialty medications including biologics and targeted synthetic disease-modifying agents has dramatically expanded the treatment options available to patients with auto-immune conditions. However, health-system innovations to ensure safe prescribing of these medications have not kept pace. These drugs are known to increase the ri
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The rapid proliferation of specialty medications including biologics and targeted synthetic disease-modifying agents has dramatically expanded the treatment options available to patients with auto-immune conditions. However, health-system innovations to ensure safe prescribing of these medications have not kept pace. These drugs are known to increase the risk of reactivation of life-threatening infections, including HBV, HCV, and latent TB. Despite recommendations endorsed by the National Quality Forum (NQF), a large fraction patients receiving these medications nationwide are missing screening tests for TB, HBV, and HCV.
Hydroxychloroquine (HCQ) is a conventional DMARD commonly used for patients with rheumatoid arthritis or systemic lupus erythematous. Although long-term use of HCQ can cause retinal toxicity, this risk can be reduced if high doses of the drug are avoided. Studies suggest that many patients are receiving higher than recommended doses of this drug. See more
Hydroxychloroquine (HCQ) is a conventional DMARD commonly used for patients with rheumatoid arthritis or systemic lupus erythematous. Although long-term use of HCQ can cause retinal toxicity, this risk can be reduced if high doses of the drug are avoided. Studies suggest that many patients are receiving higher than recommended doses of this drug. See more
Files
- Study: Hydroxychloroquine dosing in immune-mediated diseases: implications for patient safety Hydroxychloroquine dosing in immune-mediated diseases: implications for patient safety
- Study: RISE registry reveals potential gaps in medication safety for new users of biologics and targeted synthetic DMARDs RISE registry reveals potential gaps in medication safety for new users of biologics and targeted synthetic DMARDs
The solution
We developed the DMARD Patient Safety App (Microsoft PowerBI) to improve the safe prescribing of biologic and conventional disease-modifying agents. This App pulls data from CDW to create a report of patients who have and have not received appropriate screening tests (among biologic/targeted small molecule users) and drug dose (among hydroxychloroquine users
...
We developed the DMARD Patient Safety App (Microsoft PowerBI) to improve the safe prescribing of biologic and conventional disease-modifying agents. This App pulls data from CDW to create a report of patients who have and have not received appropriate screening tests (among biologic/targeted small molecule users) and drug dose (among hydroxychloroquine users). These dashboards can be used for population health management to identify patients who are missing critical labs or who are receiving hydroxychloroquine at high doses.
See
more
Links
- Introduction video reviewing the aspects of each dashboard on the DMARD Patient Safety App. Introduction to the DMARD Patient Safety App
The results
Pilot testing of the App began in October 2020 and national rollout began in January 2022.
Files
- Study: Time series analysis examining the effectiveness of the Hydroxychloroquine Patient Safety Dashboard among VA pilot sites. HCQ Dashboard time series analysis manuscript
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
Above:
Results from a pragmatic trial of the VA DMARD Dashboard App: Interrupted time series analysis shows that the proportion of patients receiving high doses of hydroxychloroquine decreased over time among pilot facilities compared to controls.
Implementation
Timeline
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Spring 2022
The DMARD Patient Safety Dashboard App is available to all VA personnel with access to CPRS.
Departments
- Dermatology
- Gastroenterology
- Hematology/Oncology
- Pharmacy
- Rheumatology
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Files
- Hydroxychloroquine Patient Safety Dashboard Clinic Workflow Swimlane Diagram Example of dashboard clinic workflow
Links
- DMARD Patient Safety App Landing Page DMARD Patient Safety App
- This toolkit is to support the DMARD Patient Safety App's dashboards by providing presentations, slide decks, email templates, and other resources to aid efforts to increase pre-screenings and safe prescribing for Veteran patients on high-risk immunotherapies. DMARD Patient Safety Toolkit
Risks and mitigations
| Risk | Mitigation |
|---|---|
| Disclaimers for the DMARD Latent Infections dashboard |
TB testing information comes from lab tests, clinical note titles, or health factors, but not clinical not narratives; therefore, TB tests for some patients may not be captured in the dashboard. Providers that are *Unknown at this time* may be non-VA providers within the community. All medications are captured through "active" orders in CPRS with the exception of injections: injectable medications are captured within 1 year of their order date. |
| Disclaimers for Hydroxychloroquine Dashboard | For orders with complex medication instructions (sigs) or those that do not match the quantity dispensed, the calculated dose in mg/kg/day may be inaccurate. |
About
Origin story
Dr. Schmajuk is a rheumatologist who has studied quality of care and medication safety. She helped develop the American College of Rheumatology’s RISE registry and thought that the VA could use similar dashboards to drive patient safety and quality improvement for Veterans. This application was developed as part of the Measurement Science QUERI at the SFVAMC
...
Dr. Schmajuk is a rheumatologist who has studied quality of care and medication safety. She helped develop the American College of Rheumatology’s RISE registry and thought that the VA could use similar dashboards to drive patient safety and quality improvement for Veterans. This application was developed as part of the Measurement Science QUERI at the SFVAMC, funded by HSR&D.
Original team
Gabriela Schmajuk
Project Primary Investigator, Rheumatologist
Anna Montgomery
Program Manager, Data Analyst
Gary Tarasovsky
Data Manager, Data Analyst
Comment
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