Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology

Abstract

ObjectiveTo describe the adherence to quality of care indicators in early rheumatoid arthritis (RA) and to evaluate its impact on the risk of hospitalisation in a real-world setting.DesignRetrospective cohort study.SettingPatients with early-onset RA identified from healthcare regional administrative databases by means of a validated algorithm between 2006 and 2012 in the Lombardy region (Italy).ParticipantsThe study cohort included 14 203 early-onset RA (71% female, mean age 60 years).Outcome measuresFor each patient, a summary adherence score was calculated starting from the compliance to six quality indicators: (1–2) methotrexate or sulfasalazine or leflunomide with/without glucocorticoids, (3–4) other disease-modifying antirheumatic drugs (DMARDs) with/without glucocorticoids, (5) early interruption of glucocorticoids, (6) early clinical assessment.The relationship between low, intermediate and high categories of the summary score and the 12-month risk of hospitalisation for all causes and for RA was assessed.ResultsDuring a follow-up of 1 year, 2609 hospitalisations occurred, of which 704 were for RA (main or secondary diagnosis) and 252 primarily for RA. In a 7-year period (2006–2012), early DMARDs and timely clinical monitoring treatment increased (from 52% to 62% p trend <0.001 and from 25% to 30% p trend 0.009, respectively).Intermediate and high summary adherence score categories (compared with the low category) were related significantly with a lower risk of hospitalisation (adjusted HR 0.85 (95% CI 0.77 to 0.93), p<0.001 and HR 0.76 (95% CI 0.69 to 0.84), p<0.001, respectively). Among the indicators of the adherence score, early DMARD prescription showed the strongest positive impact, while long-term use of glucocorticoids was the worst negative one.ConclusionIn early RA, adherence to quality standards of care is associated with a lower risk of hospitalisation. Future interventions to improve the adherence to quality standards of care in this setting should decrease the risk of hospitalisation with a significant impact on individual and population health.

One year in review 2021: novelties in the treatment of rheumatoid arthritis

“…tology care (around 60%), with about 60% of patients starting DMARDs within 1 months from the diagnosis (2). An Italian study confirmed these results, with more than 60% starting a DMARDs once diagnosed, of whom 62% within 1 month from the diagnosis (3). In both studies, the frequency of assessments was lower than recommended.…”

“…One year in review 2021: novelties in the treatment of rheumatoid arthritis E. Silvagni 1 , G. Sakellariou 2 , A. Bortoluzzi 1 , A. Giollo 3,4 , N. Ughi 5 , L. Vultaggio 1 , C.A. Scirè 1,6 Treatment novelties in RA / E. Silvagni et al…”

“…In both studies, the frequency of assessments was lower than recommended. The Italian study also developed a composite indicator of adherence to recommendations of early treatment, showing that patients more adherent to early DMARD treatment, with a short-time glucocorticoid (GC) trial and with earlier first re-assessment, carried a significantly lower risk of hospitalisation for RA, independently from demographic and comorbidities variables (3). Beyond quality of care and clinical outcomes, the experience of care is another relevant dimension to consider.…”

Improving rheumatoid arthritis management within the Spanish National Health System: a social return on investment study

“…Actions in these areas would be more likely to redirect the long-term course of the disease. In fact, a recent study showed that a higher de-gree of adherence to quality-of-care indicators for early RA, specially to early treatment with DMARDs, significantly reduced the risk of early hospitalisation, a measure of failure for the RA care pathway (9). Moreover, basing pharmacological and non-pharmacological treatment strategies on joint decisions between the patient, the rheumatologist, and other healthcare professionals, generated the greatest social impact relative to investment.…”

“…Moreover, classification criteria for RA have been modified to allow for an earlier diagnosis and to identify patients with undifferentiated arthritis with a high risk of developing persistent and/or erosive arthritis which should be treated with disease-modifying anti-rheumatic drugs (DMARDs) (1,6). The early treatment with DMARDs, within the T2T strategy, may prevent, halt, or minimise joint destruction (7,8), and significantly reduce early hospitalisation (9). Ultimately, the implementation of the T2T strategy aims to maximise HRQoL of patients with RA, further normalising function, activities, and participation within the patient's personal and environmental context (7,10).…”