Quality indicators for care of osteoarthritis in primary care settings: a systematic literature review

Petrosyan, Yelena; Sahakyan, Yeva; Barnsley, Jan; Kuluski, Kerry; Liu, Barbara; Wodchis, Walter P.

doi:10.1093/fampra/cmx090

Cited by 16 publications

(23 citation statements)

References 17 publications

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“…Previously published reviews 20 21 34 35 59 60 focused on QIs specific healthcare settings (eg, primary care and centralised intake care systems), or perspectives (eg, patients’ perspectives). To our knowledge, this is the first systematic review that provides a comprehensive overview of QIs for KHOA outlining the differences and similarities between healthcare settings.…”

Section: Discussionmentioning

confidence: 99%

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Quality indicators for knee and hip osteoarthritis care: a systematic review

et al. 2021

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To provide an overview of quality indicators (QIs) for knee and hip osteoarthritis (KHOA) care and to highlight differences in healthcare settings. A database search was conducted in MEDLINE (PubMed), EMBASE, CINAHL, Web of Science, Cochrane CENTRAL and Google Scholar, OpenGrey and Prospective Trial Register, up to March 2020. Studies developing or adapting existing QI(s) for patients with osteoarthritis were eligible for inclusion. Included studies were categorised into healthcare settings. QIs from included studies were categorised into structure, process and outcome of care. Within these categories, QIs were grouped into themes (eg, physical therapy). A narrative synthesis was used to describe differences and similarities between healthcare settings. We included 20 studies with a total of 196 QIs mostly related to the process of care in different healthcare settings. Few studies included patients’ perspectives. Rigorous methods for evidence synthesis to develop QIs were rarely used. Narrative analysis showed differences in QIs between healthcare settings with regard to exercise therapy, weight counselling, referral to laboratory tests and ‘do not do’ QIs. Differences within the same healthcare setting were identified on radiographic assessment. The heterogeneity in QIs emphasise the necessity to carefully select QIs for KHOA depending on the healthcare setting. This review provides an overview of QIs outlined to their healthcare settings to support healthcare providers and policy makers in selecting the contextually appropriate QIs to validly monitor the quality of KHOA care. We strongly recommend to review QIs against the most recent guidelines before implementing them into practice.

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Section: Discussionmentioning

confidence: 99%

“…Several systematic reviews have focused on QIs for OA in primary care. 20 21 However, an overview of QIs that take into account the differences in healthcare settings and countries is lacking. Such an overview will support healthcare providers and policy makers in selecting the contextually appropriate QIs.…”

Section: What Does This Study Add?mentioning

confidence: 99%

Quality indicators for knee and hip osteoarthritis care: a systematic review

et al. 2021

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“…First, systematic reviews were conducted to identify a set of evidence-based and valid quality indicators for assessing care for older adults in ambulatory care settings by each disease category, including diabetes, major depression, hypertension, chronic ischemic heart disease and osteoarthritis, as well as selected disease combinations [17, 18]. The resulting indicators were then sorted into those potentially measurable with the Ontario administrative data, and those that required other sources of data.…”

Section: Methodsmentioning

confidence: 99%

“…There are few published indicators for care for older adults with diabetes that specifically address comorbidity with concordant conditions, including hypertension and chronic ischemic heart disease [14–16]. Moreover, there are no indicators identified for care for older adults with diabetes with comorbid discordant conditions, including osteoarthritis and major depression [17, 18]. The present study addresses these gaps and aimed to: 1) critically appraise and select the most appropriate set of quality indicators for ambulatory care for older adults with five selected disease combinations that are amenable to measurement using administrative data, using a Delphi technique, including: a) concordant conditions: diabetes with comorbid hypertension and ischemic heart disease, b) discordant conditions: diabetes with comorbid osteoarthritis and depression, c) both types: diabetes with comorbid hypertension and osteoarthritis, and 2) prepare a summary of defined quality indicators by each selected disease combination.…”

Section: Introductionmentioning

confidence: 99%

Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study

et al. 2018

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BackgroundAn increasing number of people are living with multiple chronic conditions and it is unclear which quality indicators should be used to guide care for this population.ObjectiveTo critically appraise and select the most appropriate set of quality indicators for ambulatory care for older adults with five selected disease combinations.MethodsA two-round web-based Delphi process was used to critically appraise and select quality of care indicators for older adults with diabetes and comorbidities. A fifteen-member Canadian expert panel with broad geographical and clinical representation participated in this study. The panel evaluated process indicators for meaningfulness, potential for improvements in clinical practice, and overall value of inclusion, while outcome indicators were evaluated for importance, modifiability and overall value of inclusion. A 70% agreement threshold was required for high consensus, and 60–69% for moderate consensus as measured on a 5-point Likert type scale.ResultsTwenty high-consensus and nineteen medium-consensus process and outcome indicators were selected for assessing care for older adults with selected disease combinations, including 1) concordant (conditions with a common management plan), 2) discordant (conditions with unrelated management plans), and 3) both types. Panelists reached rapid consensus on quality indicators for care for older adults with concordant comorbid conditions, but not for those with discordant conditions. All selected indicators assess clinical aspects of care. The feedback from the panelists emphasized the importance of developing indicators related to patient-centred aspects of care, including patient self-management, education, patient-physician relationships, and patient’s preferences.ConclusionsThe selected quality indicators are not intended to provide a comprehensive tool set for measuring quality of care for older adults with selected disease combinations. The recommended indicators address clinical aspects of care and can be used as a starting point for ambulatory care settings and development of additional quality indicators.

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“…To measure the quality of health care for patients with knee OA, a Belgian set of 21 process QIs, based on international evidence‐based guidelines, was developed by a multidisciplinary expert panel (9). Even though OA is one of the most prevalent conditions in general practice, evidence‐based and valid QIs for assessing the quality of primary care for knee OA are scarce (10). However, numerous studies have shown that high performance on process QIs does not consequently lead to the desired patient health outcomes (11,12).…”

Section: Introductionmentioning

confidence: 99%

Quality of Care for Knee Osteoarthritis in Primary Care: A Patient’s Perspective

Spitaels

Vankrunkelsven

Grypdonck

et al. 2020

Arthritis Care & Research

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Objective To describe the quality of osteoarthritis care in general practice from a patient’s perspective and to identify novel associations between process quality indicators and patient‐reported outcome and experience measures. Methods For this study, 235 individuals with knee osteoarthritis completed a survey based on both process and outcome indicators. Process indicators were extracted from international guidelines and included the domains: diagnosis, self‐management, treatment, and follow‐up. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and RAND 36‐item Short Form health survey (SF‐36) were used to assess patient‐reported outcomes. Patient‐reported experience with care was evaluated with the European Task Force on Patient Evaluations of General Practice Care (EUROPEP) instrument. A series of multilevel regression analyses were then performed to analyze determinants at the patient level (i.e., age, sex, body mass index, and education) and associations between process and outcome indicators. Results Overall, low adherence to the process indicators was observed (38%), particularly on informing patients about the importance of weight loss (24% [95% confidence interval (95% CI) 19–31]) or referring them for physical therapy (41% [95% CI 33–49]). Patients described their quality of life as moderate, with an overall score of 63% and 35% on the SF‐36 and WOMAC surveys, respectively. Regarding the determinants, patients with a higher education level were better informed (odds ratio [OR] 3.4; P = 0.0003). Associations between process and outcome indicators were scarce, with the exception of patient satisfaction with care and use of nonsteroidal antiinflammatory drugs (NSAIDs) (OR 2.9; P = 0.0014). Conclusion Patients with knee osteoarthritis receive suboptimal conservative management. They report a moderate quality of life. This study confirms the evidence suggesting that NSAIDs are the backbone of osteoarthritis pain management but also adds evidence from a patient’s perspective.

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Quality indicators for care of osteoarthritis in primary care settings: a systematic literature review

Cited by 16 publications

References 17 publications

Quality indicators for knee and hip osteoarthritis care: a systematic review

Quality indicators for knee and hip osteoarthritis care: a systematic review

Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study

Quality of Care for Knee Osteoarthritis in Primary Care: A Patient’s Perspective

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