Journal
JOURNAL OF RHEUMATOLOGY
Volume 48, Issue 3, Pages 326-334Publisher
J RHEUMATOL PUBL CO
DOI: 10.3899/jrheum.200688
Keywords
quality improvement; quality of health care; rheumatoid arthritis
Categories
Funding
- Canadian Rheumatology Association (CRA)
- CRA
- Arthritis Alliance of Canada (AAC)
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The study aimed to develop a patient-centered quality measurement framework for rheumatoid arthritis care. Through a modified Delphi process, 21 measures were identified, covering early access to care, evidence-based treatment, patient participation, and patient outcomes. The framework builds upon existing measures and adds important PMs for high-quality RA care and outcome measurement.
Objective. 'Hie aim of this study was to develop a patient-centered quality measurement framework to address a predefined vision statement and 7 strategic objectives for rheumatoid arthritis (RA) care that was developed in prior qualitative work with arthritis stakeholders. Methods. One hundred forty-seven RA-related performance measures (PMs) were identified from a systematic review. A candidate list of 26 PMs meeting predefined criteria and addressing the strategic objectives previously defined was then assessed during a 3-round (R) modified Delphi. Seventeen panelists with expertise in RA, quality measurement, and/or lived experience with RA rated each PM on a 1-9 scale based on the items of importance, feasibility, and priority for inclusion in the framework during R1 and R3, with a moderated discussion in R2. PMs with median scores >= 7 on all 3 items without disagreement were included in the final set, which then underwent public comment. Results. Twenty-one measures were included in the final framework (15 PMs from the Delphi and 6 published system-level measures on access to care and treatment). The measures included 4 addressing early access to care and timely diagnosis, 12 evidence-based care for RA and related comorbidities, 1 addressing patient participation as an informed partner in care, and 4 on patient outcomes. Conclusion. The proposed framework builds upon existing measures capturing early access to care and treatment in RA and adds important PMs to promote high-quality RA care and outcome measurement. In the next phase, the authors will test the framework in clinical practice in addition to addressing certain areas where no suitable PMs were identified.
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