Abstract:Our review has shown that even in models of care designed to improve access to care and early treatment, data to document improvements are often lacking. Where data were available for measuring, deficits in WT performance were noted for some centers. Our results highlight a need to improve reporting processes to drive quality improvement.
“…This work builds upon previous national efforts to develop a measurement framework for monitoring and improving care for patients with inflammatory arthritis that was developed in collaboration with the AAC [15]. The AAC System-Level Performance Measure set included 6 measures that have been used to evaluate early access to care and treatment for [24][25][26][27][28]. All 3 of the measures previously included in the AAC measurement set (wait times for JIA care, percentage of patients seen within 1 year of diagnosis, and percentage of patients seen in yearly follow-up) were retained in the current measurement set.…”
Background:The evaluation of quality of care in juvenile idiopathic arthritis (JIA) is critical for advancing patient outcomes but is not currently part of routine care across all centers in Canada. The study objective is to review the current landscape of JIA quality measures and use expert panel consensus to define key performance indicators (KPIs) that are important and feasible to collect for routine monitoring in JIA care in Canada. Methods: Thirty-seven candidate KPIs identified from a systematic review were reviewed for inclusion by a working group including 3 pediatric rheumatologists. A shortlist of 14 KPIs was then assessed using a 3-round modified Delphi panel based on the RAND/UCLA Appropriateness Method. Ten panelists across Canada participated based on their expertise in JIA, quality measurement, or lived experience as a parent of a child with JIA. During rounds 1 and 3, panelists rated each KPI on a 1-9 Likert scale on themes of importance, feasibility, and priority. In round 2, panelists participated in a moderated in-person discussion that resulted in minor modifications to some KPIs. KPIs with median scores of ≥ 7 on all 3 questions without disagreement were included in the framework.
“…This work builds upon previous national efforts to develop a measurement framework for monitoring and improving care for patients with inflammatory arthritis that was developed in collaboration with the AAC [15]. The AAC System-Level Performance Measure set included 6 measures that have been used to evaluate early access to care and treatment for [24][25][26][27][28]. All 3 of the measures previously included in the AAC measurement set (wait times for JIA care, percentage of patients seen within 1 year of diagnosis, and percentage of patients seen in yearly follow-up) were retained in the current measurement set.…”
Background:The evaluation of quality of care in juvenile idiopathic arthritis (JIA) is critical for advancing patient outcomes but is not currently part of routine care across all centers in Canada. The study objective is to review the current landscape of JIA quality measures and use expert panel consensus to define key performance indicators (KPIs) that are important and feasible to collect for routine monitoring in JIA care in Canada. Methods: Thirty-seven candidate KPIs identified from a systematic review were reviewed for inclusion by a working group including 3 pediatric rheumatologists. A shortlist of 14 KPIs was then assessed using a 3-round modified Delphi panel based on the RAND/UCLA Appropriateness Method. Ten panelists across Canada participated based on their expertise in JIA, quality measurement, or lived experience as a parent of a child with JIA. During rounds 1 and 3, panelists rated each KPI on a 1-9 Likert scale on themes of importance, feasibility, and priority. In round 2, panelists participated in a moderated in-person discussion that resulted in minor modifications to some KPIs. KPIs with median scores of ≥ 7 on all 3 questions without disagreement were included in the framework.
“…During further measure testing 2 additional issues were identified: 1) billing fees may increase if the patient is seen > 12 months between appointments; 2) additionally, some stable patients who are booked 1 year following their last appointment may get booked > 12 months from their last appointment due to patient and/or physician scheduling. Therefore, an extended observation period of 14 months was built into the measure to address these issues that may not be directly related to patient quality of care [10, 11].…”
Background
The study evaluates Performance Measures (PMs) for Juvenile Idiopathic Arthritis (JIA): The percentage of patients with new onset JIA with at least one visit to a pediatric rheumatologist in the first year of diagnosis (PM1); and the percentage of patients with JIA under rheumatology care seen in follow-up at least once per year (PM2).
Methods
Validated JIA case ascertainment algorithms were used to identify cases from provincial health administrative databases in Manitoba, Canada in patients < 16 years between 01/04/2005 and 31/03/2015. PM1: Using a 3-year washout period, the percentage of incident JIA patients with ≥1 visit to a pediatric rheumatologist in the first year was calculated. For each fiscal year, the proportion of patients expected to be seen in follow-up who had a visit were calculated (PM2). The proportion of patients with gaps in care of > 12 and > 14 months between consecutive visits were also calculated.
Results
One hundred ninety-four incident JIA cases were diagnosed between 01/04/2008 and 03/31/2015. The median age at diagnosis was 9.1 years and 71% were female. PM1: Across the years, 51–81% of JIA cases saw a pediatric rheumatologist within 1 year. PM2: Between 58 and 78% of patients were seen in yearly follow-up. Gaps > 12, and > 14, months were observed once during follow-up in 52, and 34%, of cases, and ≥ twice in 11, and 5%, respectively.
Conclusions
Suboptimal access to pediatric rheumatologist care was observed which could lead to diagnostic and treatment delays and lack of consistent follow-up, potentially negatively impacting patient outcomes.
“…The 6 measures capture timely access to rheumatologist care, ongoing follow‐up, and timely and ongoing treatment for patients with inflammatory arthritis. To date, the measures have been tested in a longitudinal, early RA cohort (8) as well as using clinical data from 5 different models of care across Canada (9). This is the first time that the nationally endorsed performance measures have been operationalized using administrative data, allowing us to report on quality of care in rheumatoid arthritis at a population level.At the population level, improvements over time were seen in access to rheumatologist care and timeliness of early treatment, while suboptimal rates of rheumatology follow‐up persisted.Higher performance rates on treatment measures were observed in patients accessing rheumatologist care over the measurement period.…”
Section: Introductionmentioning
confidence: 99%
“…The 6 measures capture timely access to rheumatologist care, ongoing follow-up, and timely and ongoing treatment for patients with inflammatory arthritis. To date, the measures have been tested in a longitudinal, early RA cohort (8) as well as using clinical data from 5 different models of care across Canada (9).…”
Objective
To operationalize and report on nationally endorsed rheumatoid arthritis (RA) performance measures (PMs) using health administrative data for British Columbia (BC), Canada.
Methods
All patients with RA in BC ages ≥18 years were identified between January 1, 1997 and December 31, 2009 using health administrative data and followed until December 2014. PMs tested include: the percentage of incident patients with ≥1 rheumatologist visit within 365 days; the percentage of prevalent patients with ≥1 rheumatologist visit per year; the percentage of prevalent patients dispensed disease‐modifying antirheumatic drug (DMARD) therapy; and time from RA diagnosis to DMARD therapy. Measures were reported on patients seen by rheumatologists, and in the total population.
Results
The cohort included 38,673 incident and 57,922 prevalent RA cases. The percentage of patients seen by a rheumatologist within 365 days increased over time (35% in 2000 to 65% in 2009), while the percentage of RA patients under the care of a rheumatologist seen yearly declined (79% in 2001 to 39% in 2014). The decline was due to decreasing visit rates with increasing follow‐up time rather than calendar effect. The percentage of RA patients dispensed a DMARD was suboptimal over follow‐up (37% in 2014) in the total population but higher (87%) in those under current rheumatologist care. The median time to DMARD in those seen by a rheumatologist improved from 49 days in 2000 to 23 days in 2009, with 34% receiving treatment within the 14‐day benchmark.
Conclusion
This study describes the operationalization and reporting of national PMs using administrative data and identifies gaps in care to further examine and address.
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