Development of System-level Performance Measures for Evaluation of Models of Care for Inflammatory Arthritis in Canada

Abstract

Objective.To develop system-level performance measures for evaluating the care of patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis.Methods.This study involved several methodological phases. Over multiple rounds, various participants were asked to help define a set of candidate measurement themes. A systematic search was conducted of existing guidelines and measures. A set of 6 performance measures was defined and presented to 50 people, including patients with IA, rheumatologists, allied health professionals, and researchers using a 3-round, online, modified Delphi process. Participants rated the validity, feasibility, relevance, and likelihood of use of the measures. Measures with median ratings ≥ 7 for validity and relevance were included in the final set.Results.Six performance measures were developed evaluating the following aspects of care, with each measure being applied separately for each type of IA except where specified: waiting times for rheumatology consultation for patients with new onset IA, percentage of patients with IA seen by a rheumatologist, percentage of patients with IA seen in yearly followup by a rheumatologist, percentage of patients with RA treated with a disease-modifying antirheumatic drug (DMARD), time to DMARD therapy in RA, and number of rheumatologists per capita.Conclusion.The first set of system-level performance measures for IA care in Canada has been developed with broad input. The measures focus on timely access to care and initiation of appropriate treatment for patients with IA, and are likely to be of interest to other arthritis care systems internationally.

High Adherence to System‐Level Performance Measures for Rheumatoid Arthritis in a National Early Arthritis Cohort Over Eight Years

“…In comparison, wait‐time benchmarks for DMARD start times are more stringent in our Canadian set than in the NICE quality standards from the UK, yet higher rates of adherence are reported in our study (75% within 14 days of diagnosis in CATCH compared to 53% treated within 6 weeks of referral in the UK) 27. Unfortunately, the complementary measure of waiting time to rheumatology care, that captures the time between rheumatologist referral and first visit for patients with RA 7, was not captured in CATCH and is being evaluated in other data sources, including triage databases across the country. In the UK, adherence to the NICE quality standard wait‐time benchmark of 3 weeks for rheumatologist consultation was poor (38%) 27, likely contributing to the lower rates of timely treatment seen, as the measure for time‐to‐treatment was anchored at the referral date.…”

“…Also the paradigm for the diagnosis of patients recruited before the 2010 ACR/EULAR criteria 11 were published may have meant that patients were being treated off‐label before a formal RA diagnosis was made according to the older ACR criteria 10. When calculating the median and 90th percentile, as recommended when reporting on this measure 7, this calculation incurred negative values for the patients treated before diagnosis. Therefore, the performance measure was reported in 2 ways.…”

“…Guidelines, quality standards, and quality indicators recommend that RA patients be seen at least yearly in followup to evaluate their disease status, screen for comorbidities, and review medications 5, 7, 28, 29. There has unfortunately been little published evaluation on RA patients who may have gaps in care or get lost to followup and on the consequences of lack of rheumatologist care.…”

A Systematic Review of Quality Measures for Inflammatory Arthritis

“…From the 13 sources ( 16,17 , and 1 was a pan-European set 18 ). Most of the sets were for RA 6,7,9,11,12,13,[15][16][17][18] (n = 10, 77%) with 1 each (8%) for JIA 10 , PsA 14 , and inflammatory arthritis 8 . No sets were found for ReA and none accepted for AS.…”

Ювенильный Анкилозирующий Спондилит (Обзор Литературы И Собственные Данные)

“…Установлено, что больные с трансформацией АС из ювенильного обычно более высокого роста, хотя другие антропометрические параметры не от-личаются [36], у такой группы пациентов чаще воз-никают показания к проведению артропластики и протезирования тазобедренных суставов по по-воду коксита [20]. Отмечается определенная эво-люция клинических проявлений ЮАС у взрослых больных [3]. D.R.…”