Overview of the American College of Rheumatology's Electronic Health Record-Enabled Registry: The Rheumatology Informatics System for Effectiveness.

The Rheumatology Informatics System for Effectiveness (RISE) Registry was developed by the American College of Rheumatology (ACR) to serve US rheumatologists for the significant challenges of a rapidly changing healthcare environment. More than 400 rheumatologists have sent data from more than 3 million encounters of more than 650,000 patients as of August 11, 2016, through their electronic medical records (EMRs), with no additional work or interference with workflow on the part of the rheumatologists. RISE includes patients with all diagnoses seen by participating rheumatologists, at no cost to the rheumatologist.

Development of the American College of Rheumatology's Rheumatoid Arthritis Electronic Clinical Quality Measures.

OBJECTIVE: Electronic clinical quality measures (eCQMs) rely on computer algorithms to extract data from electronic health records (EHRs). On behalf of the American College of Rheumatology (ACR), we sought to develop and test eCQMs for rheumatoid arthritis (RA). METHODS: Drawing from published ACR guidelines, a working group developed candidate RA process measures and subsequently assessed face validity through an interdisciplinary panel of health care stakeholders. A public comment period followed. Measures that passed these levels of review were electronically specified using the quality data model, which provides standard nomenclature for data elements (category, datatype, and value sets) obtained through an EHR. For each eCQM, 3 clinical sites using different EHR systems tested the scientific feasibility and validity of measures. Measures appropriate for accountability were presented for national endorsement. RESULTS: Expert panel validity ratings were high for all measures (median 8-9 of 9). Health system performance on the eCQMs was 53.6% for RA disease activity assessment, 69.1% for functional status assessment, 93.1% for disease-modifying antirheumatic drug (DMARD) use, and 72.8% for tuberculosis screening. Kappa statistics, which evaluated whether the eCQM validly captured data obtained from manual EHR chart review, demonstrated moderate to substantial agreement (0.54 for functional status assessment, 0.73 for tuberculosis screening, 0.84 for disease activity, and 0.85 for DMARD use). CONCLUSION: Four eCQMs for RA have achieved national endorsement and are recommended for use in federal quality reporting programs. Implementation and further refinement of these measures is ongoing in the ACR's registry, the Rheumatology Informatics System for Effectiveness (RISE).

The effect of childhood sexual abuse on adolescent pregnancy: an integrative research review.

PURPOSE: This study aims to describe the current research literature on the relationship of childhood sexual abuse and adolescent pregnancy and highlight the potential cross-cutting risk factors. DESIGN AND METHODS: Thirteen articles were identified as the basis of this review using Cooper's methodology (1998) for synthesizing research. Articles were categorized according to the levels of evidence proposed by Melnyk and Fineout-Overholt (2005). RESULTS: The majority of the studies identified a relationship between childhood sexual abuse and adolescent pregnancy (n=9). Cross-cutting risk factors included female gender, younger age, substance use/abuse, family constellation, parent-child conflict, and mother disengagement. PRACTICE IMPLICATIONS: Strategies for nurses to identify pregnant and parenting adolescents who have been sexually victimized are important for early intervention. Resiliency factors of young people who report positive outcomes are highlighted.