Improving Lipid Screening Adherence in Inflammatory Arthritis Using a Two-Cycle Plan-Do-Study-Act (PDSA) Quality...

Autoimmune diseases, such as rheumatoid arthritis (RA) and spondylarthritis (SpA), including ankylosing spondylitis (AS) and psoriatic arthritis (PsA), are characterized by chronic systemic inflammation and are associated with significant cardiovascular morbidity and mortality. Dyslipidemia is a well-established contributor to this increased cardiovascular risk and represents an important comorbidity in patients with rheumatologic disease.

This pre-post interventional quality improvement (QI) study used two iterative Plan-Do-Study-Act (PDSA) cycles at a high-volume, academic rheumatology clinic to improve provider adherence to lipid screening guidelines for patients with seropositive RA, PsA, or AS, as determined by International Classification of Diseases 10th Revision (ICD-10) codes. Patients were excluded if they had a diagnosis of systemic lupus erythematosus (SLE), juvenile dermatomyositis, Sjogren syndrome, or arthropathic psoriasis, or if they were managed at other rheumatology clinics within the Houston Methodist system.

Baseline screening rates were established via retrospective chart review between July 2024 and February 2025. PDSA Cycle 1 spanned from March to April of 2025 and involved the deployment of provider education, physical and email reminders, and a custom Epic dot phrase. PDSA Cycle 2 spanned from April to May of 2025 and consisted of pre-visit chart review and the placement of a pending lipid panel into the electronic health record (EHR) if needed. The primary outcome was the percentage of eligible patients with a completed lipid panel in the preceding 12 months.

Retrospective chart review at baseline indicated a care gap, with 62.4% (98/157) of eligible patients having completed a lipid panel within the prior 12 months. Interventions for PDSA Cycle 1 resulted in the rheumatology providers ordering two lipid panels for patients, yet the total screening rate with the intervention was 57.1% (28/49), lower than baseline. The process interventions in PDSA Cycle 2 drastically increased the lipid screening rate to 92.8% (13/14).

The QI initiative demonstrated that system-level workflow interventions incorporating pre-visit chart review and preemptive order entry were associated with improved lipid screening adherence among patients with RA, PsA, and AS. Educational interventions and passive EHR-based tools alone did not result in sustained improvement. These findings highlight the importance of embedding preventive care measures directly into clinical workflows to improve adherence to cardiovascular risk screening guidelines in rheumatology practice.