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A Fellow-Led Quality Improvement Initiative to Increase Disease Activity Measurement in a Busy Academic Rheumatology
Morgan Lilly1, Ruba Memon2, Kamilla Guinn3
1Medicine, Texas A&M University School of Engineering Medicine, Houston, USA.
Cureus
|May 25, 2026
Summary
A quality improvement project successfully increased Clinical Disease Activity Index (CDAI) documentation in rheumatoid arthritis (RA) care using an electronic health record (EHR) template. This supports better adherence to American College of Rheumatology guidelines.
Area of Science:
- Rheumatology
- Quality Improvement
- Health Informatics
Background:
- The treat-to-target (T2T) strategy is preferred for rheumatoid arthritis (RA) management, emphasizing disease activity assessment.
- Consistent documentation of disease activity, often via the Clinical Disease Activity Index (CDAI), is crucial but variable in academic settings.
Purpose of the Study:
- To improve the documentation of Clinical Disease Activity Index (CDAI) scores in rheumatoid arthritis (RA) patient encounters within an academic rheumatology clinic.
Main Methods:
- A fellow-led quality improvement project used a Plan-Do-Study-Act (PDSA) framework.
- An electronic health record (EHR)-integrated templated dot phrase was implemented as an intervention.
- Provider education and post-intervention surveys assessed usability and impact.
Main Results:
- Baseline CDAI documentation was 0.77% (2/261 encounters).
- Post-intervention, CDAI was documented in 72.2% (39/54 encounters).
- 100% of providers found the dot phrase useful, and 75% reported improved clinical behaviors.
Conclusions:
- A simple EHR-based intervention significantly improved CDAI documentation for RA care.
- Fellow-led quality improvement initiatives can enhance guideline-concordant care in rheumatology.
- EHR templates support efficient documentation and adherence to American College of Rheumatology guidelines.
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