PROSPERO CRD42016040020 (submitted June 8, 2016, and last revised June 14, 2016).

ABSTRACT. Objective. To conduct a systematic review and quality appraisal of quality measures for inflammatory arthritis, including rheumatoid arthritis (RA), spondyloarthritis, psoriatic arthritis (PsA), and juvenile idiopathic arthritis (JIA). Methods. Embase, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from January 1, 2000, to October 23, 2016, using Medical Subject Headings terms for inflammatory arthritis and quality measures. A "grey literature" search of international arthritis organizations and quality measure libraries was also conducted. Two reviewers independently considered the papers for inclusion, with disagreements resolved by consensus. A modified guideline appraisal tool (AGREE II) was used to appraise the measure development process, which determined final inclusion. Quality measures are tools for measuring whether care provided is concordant with evidence-based practices. They often represent minimum standards of care and are derived from quality indicators, which are statements about best practices that are associated with high-quality care. Quality indicators are usually specified in the following format: If (a specific clinical scenario), then (a clinical action) 1 . An oftencited example of a quality indicator would be if a patient has rheumatoid arthritis (RA), then they should be prescribed a disease-modifying antirheumatic drug (DMARD) 1 . Quality indicators can be further specified into quality measures, which have a specific numerator, denominator, and exclusions and can be reported as a percentage representing a quality or performance measure (depending on whether the subject of measurement is associated with improved quality or just healthcare performance). Quality measures can be used for benchmarking and quality improvement efforts, and in some countries and jurisdictions, are used in pay-forperformance programs. An example of a quality measure based on the above quality indicator would be "the percentage of patients with RA who have been prescribed a DMARD." According to a classic Donabedian framework 2 , quality measures are often classified into process, structure, or outcome. Process measures determine whether clinical processes are concordant with evidence-based best practice and improved patient outcomes; structure measures record whether the health system or clinic infrastructures are present RheumatologyThe Journal of on May 11, 2018 -Published by www.jrheum.org Downloaded from to support best practices; and outcome measures determine the effect on the health status of the patient. While outcome measures may seem the most obvious to measure, patient outcomes are the result of many factors, some of which are beyond the control of physicians. Several domains of quality exist, and the most commonly cited framework is the Institute of Medicine's 6 Domains of Health Care Quality 3 : safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.The present systematic review of quality measures in rheumatology was...

BackgroundPrimary care electronic medical record (EMR) data are being used for research, surveillance, and clinical monitoring. To broaden the reach and usability of EMR data, case definitions must be specified to identify and characterize important chronic conditions. The purpose of this study is to identify all case definitions for a set of chronic conditions that have been tested and validated in primary care EMR and EMR-linked data. This work will provide a reference list of case definitions, together with their performance metrics, and will identify gaps where new case definitions are needed.MethodsWe will consider a set of 40 chronic conditions, previously identified as potentially important for surveillance in a review of multimorbidity measures. We will perform a systematic search of the published literature to identify studies that describe case definitions for clinical conditions in EMR data and report the performance of these definitions. We will stratify our search by studies that use EMR data alone and those that use EMR-linked data. We will compare the performance of different definitions for the same conditions and explore the influence of data source, jurisdiction, and patient population.DiscussionEMR data from primary care providers can be compiled and used for benefit by the healthcare system. Not only does this work have the potential to further develop disease surveillance and health knowledge, EMR surveillance systems can provide rapid feedback to participating physicians regarding their patients. Existing case definitions will serve as a starting point for the development and validation of new case definitions and will enable better surveillance, research, and practice feedback based on detailed clinical EMR data.Systematic review registrationPROSPERO CRD42016040020 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0431-9) contains supplementary material, which is available to authorized users.