A quality indicator set for systemic lupus erythematosus

Abstract

Objective. To systematically develop a quality indicator (QI) set for systemic lupus erythematosus (SLE).Methods. We used a validated process that combined available scientific evidence and expert consensus to develop a QI set for SLE. We extracted 20 candidate indicators from a systematic literature review of clinical practice guidelines pertaining to SLE. An advisory panel revised and augmented these candidate indicators and, through 2 rounds of voting, arrived at 25 QIs. These QIs advanced to the next phase of the project, in which we employed a modification of the RAND/UCLA Appropriateness Method. A systematic review of the literature was performed for each QI, linking the proposed process of care to potential improved health outcomes. After reviewing this scientific evidence, a second interdisciplinary expert panel convened to discuss the evidence and provide final ratings on the validity and feasibility of each QI. Results. The final expert panel rated 20 QIs as both valid and feasible. Areas covered included diagnosis, general preventive strategies (e.g., vaccinations, sun avoidance counseling, and screening for cardiovascular disease), osteoporosis prevention and treatment, drug toxicity monitoring, renal disease, and reproductive health. Conclusion. We employed a rigorous multistep approach with systematic literature reviews and 2 expert panels to develop QIs for SLE. This new set of indicators provides an opportunity to assess health care quality in patients with SLE and represents an initial step toward the important goal of improving care in this patient population. INTRODUCTIONLong-term survival of patients with systemic lupus erythematosus (SLE) has improved greatly over the last several decades, but morbidity from the disease and complications of medical therapy remain important concerns. Although many studies have explored risk factors associated with poor outcomes in SLE (1-4), few studies have investigated the quality of health care received by patients with this condition (5,6). One important barrier to such research is the lack of consensus on health care processes constituting high-quality care in SLE. We aimed to address this gap by developing a quality indicator (QI) set for SLE.Over the last decade, research focusing on quality measurement in health care has burgeoned, partly in response to the initiative launched by the Institute of Medicine in 1996 to assess and improve health care quality. The Institute of Medicine defined quality as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (7). In the US, the most commonly used tools to measure quality have taken the form of QIs, defined as "retrospectively measurable elements of practice performance for which there is evidence or consensus that can be used to assess the qual- Arthritis & Rheumatism (Arthritis Care & Research) Vol. 61, No. 3, March 15, 2009, pp 370 -377 DOI 10.1002/art.24356 © 2009, American College ...

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