A Systematic Review of Quality Measures for Inflammatory Arthritis

Abstract

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...

A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; development and pilot testing

“…The literature search was updated in March 2019. Eighty-one new publications were identified, of which three described QIs or quality measures for different managements of rheumatoid arthritis and osteoarthritis [16], psoriatic arthritis [17] and inflammatory arthritis [18]. One paper described human rights based indicator framework systems to assess countries´ efforts to strengthen rehabilitation provision and policy [22].…”

“…QI sets to manage different rheumatic diseases have been developed [13–18]. Some of the QIs are adapted to a specific diagnosis, others are more generic.…”

“…Some of the QIs are adapted to a specific diagnosis, others are more generic. However, most quality sets mainly include process indicators, some of them related to rehabilitation and some not, and the development processes were suboptimal [15, 18]. Comprehensive and resource demanding quality assurance and accreditation systems for social and rehabilitation services exist [19–21], as do human rights based indicator framework systems to assess countries´ efforts to strengthen rehabilitation provision and policy [22].…”

Development of a Canadian Core Clinical Dataset to Support High-quality Care for Canadian Patients with Rheumatoid Arthritis

“…The project was approved by the University of Calgary Ethics (ID: REB16-1551) and deemed exempt from review by the RAND's Human Subjects Protection Committee (ID: 2016-0663). Data elements required for the provision of high-quality care in RA were identified in a previously published systematic review 26 . As a result of the meeting in Phase 1, during which the data elements from the systematic review and survey were discussed, a list of 41 data elements in 10 categories was proposed, including demographics, dates (e.g., dates of referral, first visit, diagnosis, symptom onset), clinical data (e.g., height, weight, disease activity), comorbidities, smoking status, patient-reported outcomes, medications, laboratory and radiographic data, and vaccinations (Table 2).…”

A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care

“…A systematic search of KPIs for inflammatory arthritis including JIA that has previously been published was updated to ensure the framework was aligned with existing KPIs, quality improvement efforts, and clinical practice guidelines [17]. To identify any new indicators that were developed since the original search, the search strategy was updated in January 2019.…”