QI Program

Quality Improvement

Dr. Janice Lin oversees the Division’s Quality Improvement (QI) Program.  As part of its mission to achieve excellence in patient care, the Division of Immunology and Rheumatology supports a robust program in Quality Improvement.   Quality Improvement follows a systematic process of identifying a clinical challenge and its key drivers, designing interventions to improve patient care quality and safety, and implementing these new approaches.

All Rheumatology Fellows  are required to complete a quality improvement project as part of their training. The “Realizing Improvement Through Team Empowerment” (RITE) and the “Clinical Effectiveness Leadership Training” (CELT) programs facilitate this training. Fellows join multidisciplinary teams (e.g., immunology-rheumatology fellow, statistician, and faculty member) to focus on a challenge in patient care that they are passionate about solving.

Examples of Quality Improvement Projects:

  • Expediting rheumatoid arthritis clinic visits
  • Increasing seasonal influenza vaccinations in rheumatology patients
  • Managing corticosteroid side effects to improve bone health


Patient visits for rheumatoid arthritis treatment were streamlined by incorporating the RAPID3 (Routine Assessment of Patient Index Data 3), a rheumatoid arthritis multi-dimensional disease questionnaire filled out by the patient. Through this project, the patient completes a questionnaire before their visit, and the responses are populated in the rheumatologist’s notes, allowing more time to discuss the patient’s treatment. Years after this QuaIity Improvement project was completed, the response rate for this questionnaire is over 80%.

Increasing seasonal influenza vaccinations:

Seasonal influenza vaccinations are important for rheumatology patients who are immunocompromised due to their treatments. This project tracked rheumatology clinic patients’ flu vaccinations with the goal of educating patients who had declined vaccinations about the significant benefit that the flu vaccine can provide them. Another approach to improving flu vaccination rates was to contact rheumatology clinic patients to inform them about Stanford primary care’s mobile influenza vaccination clinics so that patients did not have to travel to Stanford for their flu shots.

Managing corticosteroid side effects:

Corticosteroids used to treat rheumatologic diseases can cause osteoporosis and lower bone density. The QI team focused their efforts on educating and helping our clinicians to order bone density scans in at-risk patients. In addition, a prednisone order set was created to include bone density scans for osteoporosis and referral to endocrinology to streamline care when prednisone is prescribed. This Quality Improvement project increased the percentage of patients who received bone density scans to manage this side effect of their corticosteroid treatments.