Integrating Patient-Reported Quality Measures in Systemic Lupus Erythematosus: Development of the American College of Rheumatology Implementation Guide.

Abstract

To support high-quality, patient-centered care for systemic lupus erythematosus (SLE), the American College of Rheumatology (ACR) developed evidence-based measures incorporating clinical and patient-reported outcome measures (PROMs). Using the Consolidated Framework for Implementation Research (CFIR), we conducted semistructured interviews with rheumatologists and support staff who piloted these measures. Insights from these interviews informed development of the SLE Quality Measures Implementation Guide for national dissemination. Five rheumatology practices were selected to pilot workflows for collecting SLE PROMs recommended in recent ACR guidelines for at least 50 consecutive patients. Measures included physical function (PF) and depression. After data collection, representatives from each practice participated in virtual semistructured interviews. Interviews were recorded, transcribed verbatim, and analyzed thematically using both deductive and inductive techniques. Findings were used to develop the SLE Quality Measures Implementation Guide. A total of 31 clinicians across five practices participated in the pilot. Interviews with eight participants identified key themes related to innovations, resources, best practices, and challenges in collecting and using SLE PROMs, mapped to CFIR domains. Despite barriers related to workflow, engagement, and resources, PROM implementation in SLE care was well accepted and supported standardized assessment of mental health and PF through communication and electronic health records integration. These insights informed development of the SLE Quality Measures Implementation Guide, featuring guidelines, workflow recommendations, best practices, and educational resources to improve workflow efficiency and enhance patient care. This study evaluated the implementation of ACR-recommended SLE PROMs and provides actionable recommendations and resources to address challenges through the SLE Quality Measures Implementation Guide.