Evaluating Quality of Care for Rheumatoid Arthritis for the Population of Alberta Using System-level Performance Measures

Abstract

Objective We evaluated 4 national rheumatoid arthritis (RA) system-level performance measures (PMs) in Alberta, Canada. Methods Incident and prevalent RA cases ≥ 16 years of age since 2002 were identified using a validated case definition applied in provincial administrative data. Performance was ascertained through analysis of health data between fiscal years 2012/13-2015/16. Measures evaluated were: proportion of incident RA cases with a rheumatologist visit within one year of first RA diagnosis code (PM1); proportion of prevalent RA patients dispensed a disease modifying anti-rheumatic drug (DMARD) annually (PM2); time from first visit with an RA code to DMARD dispensation, and proportion of incident cases where the 14-day benchmark for dispensation was met (PM3); and proportion of patients seen in annual follow-up (PM4). Results There were 31566 prevalent and 2730 incident RA cases (2012/13). Over the analysis period, the proportion of patients seen by a rheumatologist within 1 year of onset (PM1) increased from 55 to 63%; however, the proportion of RA patients dispensed DMARDs annually (PM2) remained low at 43%. While the median time to DMARD from first visit date in people who received DMARDs improved over time from 39 to 28 days, only 38-41% of patients received treatment within the 14-day benchmark (PM3). The percentage of patients seen in yearly follow-up (PM4) varied between 73-80%. Conclusion The existing Alberta health care system for RA is suboptimal, indicating barriers to accessing specialty care and treatment. The results inform quality improvement initiatives required within the province to meet national standards of care.

Evaluation of Rheumatology Workforce Supply Changes in Ontario, Canada, from 2000 to 2030

“…It is well established that rheumatology specialty care is vital to the timely and accurate diagnosis and treatment of RMDs and to improving health outcomes of various RMD-affected populations ( Gossec et al 2016 ; Keeling et al 2018 ; Monti et al 2015 ). Currently, Canadian healthcare for RMDs is suboptimal, indicating barriers to accessing rheumatology specialty care and timely treatment ( Barber et al 2020 ; Lacaille et al 2005 ; Widdifield et al 2016b ). Rheumatology is one of the most frequent non-surgical specialty referrals ( Liddy et al 2017 ) and has the longest wait times for subspecialists ( Jaakkimainen et al 2014 ; Shadd et al 2011 ), far exceeding established benchmarks for timely care ( Barber et al 2020 ; Widdifield et al 2016a , 2016b).…”

“…Currently, Canadian healthcare for RMDs is suboptimal, indicating barriers to accessing rheumatology specialty care and timely treatment ( Barber et al 2020 ; Lacaille et al 2005 ; Widdifield et al 2016b ). Rheumatology is one of the most frequent non-surgical specialty referrals ( Liddy et al 2017 ) and has the longest wait times for subspecialists ( Jaakkimainen et al 2014 ; Shadd et al 2011 ), far exceeding established benchmarks for timely care ( Barber et al 2020 ; Widdifield et al 2016a , 2016b). High-volume rheumatology practices have been reported as a barrier to providing guideline-concordant care ( Haraoui et al 2012 ).…”

“…Ontario, being the most populous Canadian province, contains the largest Canadian rheumatology workforce, and while rheumatology supply differs across Canada, changing workforce characteristics in Ontario are likely to be generalizable to the Canadian rheumatology workforce as a whole. Ontario also contains a validated physician registry linkable to health services data, whereas, in many other Canadian provinces, there is no identifier to distinguish rheumatologists from internists in their provincial administrative data sets ( Barber et al 2020 ), making it difficult to evaluate health services use by patients of rheumatologists.…”

System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002–2019

“…Two PMs [ 3 ] were operationalized as previously described [ 4 , 5 ], and assessed between 2002 and 2020 for patients entering the cohort in each year. The first PM reports on access to rheumatologist care and is calculated as the percentage of incident RA patients seen by a rheumatologist within 365 days of their first RA diagnosis code by any physician.…”

“…National RA system-level performance measures (PMs) have been developed to measure access to rheumatologists and treatment in Canada [ 3 ]. Previous evaluations of the PMs using provincial health administrative data in Alberta [ 4 ], British Columbia [ 5 ] and Ontario [ 6 ] have demonstrated gaps in care including poor access to rheumatologist care and suboptimal dispensation of appropriate therapy with disease modifying anti-rheumatic drugs (DMARDs). Furthermore, there remain concerns about the supply of rheumatologists nationally, regionally [ 7 ] and internationally [ 8 , 9 ], and it is unclear to what degree this impacts access to RA care.…”