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Kiltz U, Buschhorn-Milberger V, Albrecht K, Lakomek HJ, Lorenz HM, Rudwaleit M, Schneider M, Schulze-Koops H, Aringer M, Hasenbring MI, Herzer P, von Hinüber U, Krüger K, Lauterbach A, Manger B, Oltman R, Schuch F, Schmale-Grede R, Späthling-Mestekemper S, Zinke S, Braun J. [Development of quality standards for patients with rheumatoid arthritis for use in Germany]. Z Rheumatol 2022; 81:744-759. [PMID: 34652486 PMCID: PMC9646547 DOI: 10.1007/s00393-021-01093-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Despite a qualitatively and structurally good care of patients with rheumatoid arthritis (RA) in Germany, there are still potentially amendable deficits in the quality of care. For this reason, the German Society for Rheumatology (DGRh) has therefore decided to ask a group of experts including various stakeholders to develop quality standards (QS) for the care of patients with RA in order to improve the quality of care. The QS are used to determine and quantitatively measure the quality of care, subject to relevance and feasibility. The recently published NICE and ASAS standards and a systematic literature search were used as the basis for development. A total of 8 QS, now published for the first time, were approved with the intention to measure and further optimize the quality of care for patients with RA in Germany.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
- Ruhr-Universität Bochum, Bochum, Deutschland.
| | | | - K Albrecht
- Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland
| | - H-J Lakomek
- Johannes-Wesling-Klinikum Minden, Universitätsklinik für Geriatrie, Minden, Deutschland
| | - H-M Lorenz
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - M Rudwaleit
- Universitätsklinik für Innere Medizin und Rheumatologie, Klinikum Bielefeld Rosenhöhe, Universität Bielefeld, Bielefeld, Deutschland
| | - M Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - H Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, LMU-Klinikum München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Aringer
- Medizinische Klinik und Poliklinik III, Rheumatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - M I Hasenbring
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - P Herzer
- Medicover München MVZ, München, Deutschland
| | - U von Hinüber
- Praxis für Rheumatologie und Osteologie, Hildesheim, Deutschland
| | - K Krüger
- Rheumatologisches Praxiszentrum St. Bonifatius, München, Deutschland
| | - A Lauterbach
- Physiotherapieschule Friedrichsheim, Friedrichsheim, Deutschland
| | - B Manger
- Medizinische Klinik 3 Rheumatologie und Immunologie, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen/Nürnberg, Erlangen, Deutschland
| | - R Oltman
- Hochschule für Gesundheit Bochum, Bochum, Deutschland
| | - F Schuch
- Rheumatologische Schwerpunktpraxis Erlangen, Erlangen, Deutschland
| | | | | | - S Zinke
- Rheumatologische Schwerpunktpraxis Zinke, Berlin, Deutschland
- Bundesverband Deutscher Rheumatologen e. V. (BDRh), Grünwald, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland
- Ruhr-Universität Bochum, Bochum, Deutschland
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Ignacio García E, Martin-Delgado J, Navaz Tejero J, Zarco Montejo P, Juanola Roura X, Mira Solves JJ. Estándares de calidad en Atención Primaria para pacientes con espondiloartritis axial: una revisión de la literatura. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/150304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introducción: la espondiloartrtis axial (Esp-Ax) es una enfermedad inflamatoria crónica del esqueleto axial. Su inicio insidioso y baja prevalencia dificultan un diagnóstico temprano. Por eso cada vez más el involucramiento de la Atención Primaria y el médico de familia gana más relevancia para una adecuada coordinación para el control de la enfermedad y la detección oportuna de comorbilidades. El objetivo de este estudio fue identificar estándares de calidad para la atención de pacientes con Esp-Ax con especial énfasis en la Atención Primaria.
Métodos: se hizo una revisión de la literatura en las siguientes bases de datos: MEDLINE, EMBASE y Cochrane Library para la identificación de publicaciones y literatura gris que validen o reporten estándares de calidad para la atención de pacientes con Esp-Ax, con especial énfasis en la Atención Primaria. No se aplicaron restricciones de idioma, fecha ni de tipología de documentos para obtener una búsqueda más amplia.
Resultados: fueron identificados 161 documentos, de los cuales 3 cumplieron con los criterios de inclusión. Los estándares fueron agrupados siguiendo el modelo de Donabedian, 7 estándares de estructura, 3 estándares de proceso y 10 estándares de resultado.
Conclusiones. La mejora de la práctica clínica depende de la identificación de oportunidades de mejora. Los estándares de calidad persiguen este objetivo, para disminuir la variabilidad clínica, mejorar los resultados y aumentar la satisfacción de las personas con la atención prestada.
Palabras clave: espondiloartritis, Atención Primaria, calidad asistencial.
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Affiliation(s)
| | - Jimmy Martin-Delgado
- Grupo de Investigación Atenea. Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO). Sant Joan d’Alacant (España)
| | | | | | | | - José Joaquín Mira Solves
- Departamento de Salud Alicante-Sant Joan. Alicante (España). Universidad Miguel Hernández. Elche (España). Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Alicante (España)
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Ignacio García E, Martin-Delgado J, Navaz Tejero J, Zarco-Montejo P, Juanola Roura X, Mira Solves JJ. Estándares de calidad en Atención Primaria para pacientes con espondiloartritis axial: una revisión de la literatura. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/rcmf.150304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introducción: la espondiloartrtis axial (Esp-Ax) es una enfermedad inflamatoria crónica del esqueleto axial. Su inicio insidioso y baja prevalencia dificultan un diagnóstico temprano. Por eso cada vez más el involucramiento de la Atención Primaria y el médico de familia gana más relevancia para una adecuada coordinación para el control de la enfermedad y la detección oportuna de comorbilidades. El objetivo de este estudio fue identificar estándares de calidad para la atención de pacientes con Esp-Ax con especial énfasis en la Atención Primaria.
Métodos: se hizo una revisión de la literatura en las siguientes bases de datos: MEDLINE, EMBASE y Cochrane Library para la identificación de publicaciones y literatura gris que validen o reporten estándares de calidad para la atención de pacientes con Esp-Ax, con especial énfasis en la Atención Primaria. No se aplicaron restricciones de idioma, fecha ni de tipología de documentos para obtener una búsqueda más amplia.
Resultados: fueron identificados 161 documentos, de los cuales 3 cumplieron con los criterios de inclusión. Los estándares fueron agrupados siguiendo el modelo de Donabedian, 7 estándares de estructura, 3 estándares de proceso y 10 estándares de resultado.
Conclusiones: la mejora de la práctica clínica depende de la identificación de oportunidades de mejora. Los estándares de calidad persiguen este objetivo, para disminuir la variabilidad clínica, mejorar los resultados y aumentar la satisfacción de las personas con la atención prestada.
Palabras clave: espondiloartritis, Atención Primaria, calidad asistencial.
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Affiliation(s)
| | - Jimmy Martin-Delgado
- Grupo de Investigación Atenea. Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO). Sant Joan d’Alacant (España)
| | | | | | | | - José Joaquín Mira Solves
- Departamento de Salud Alicante-Sant Joan. Alicante (España). Universidad Miguel Hernández. Elche (España). Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Alicante (España)
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Loza E, Carmona L, Woolf A, Fautrel B, Courvoisier DS, Verstappen S, Aarrestad Provan S, Boonen A, Vliet Vlieland T, Marchiori F, Jasinski T, Van der Elst K, Ndosi M, Dziedzic K, Carrasco JM. Implementation of recommendations in rheumatic and musculoskeletal diseases: considerations for development and uptake. Ann Rheum Dis 2022; 81:1344-1347. [PMID: 35961760 DOI: 10.1136/ard-2022-223016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
A clinical guideline is a document with the aim of guiding decisions based on evidence regarding diagnosis, management and treatment in specific areas of healthcare. Specific to rheumatic and musculoskeletal diseases (RMDs), adherence to clinical guidelines recommendations impacts the outcomes of people with these diseases. However, currently, the implementation of recommendations is less than optimal in rheumatology.The WHO has described the implementation of evidence-based recommendations as one of the greatest challenges facing the global health community and has identified the importance of scaling up these recommendations. But closing the evidence-to-practice gap is often complex, time-consuming and difficult. In this context, the implementation science offers a framework to overcome this scenario.This article describes the principles of implementation science to facilitate and optimise the implementation of clinical recommendations in RMDs. Embedding implementation science methods and techniques into recommendation development and daily practice can help maximise the likelihood that implementation is successful in improving the quality of healthcare and healthcare services.
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Affiliation(s)
- Estibaliz Loza
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro, UK
| | - Bruno Fautrel
- Rheumatology, Pitie Salpetriere Hospital - Assistance Publique-Hopitaux de Paris, Paris, France
- INSERM UMRS 1136, Sorbonne University, Paris, France
| | | | - Suzanne Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastrich University Medical Center+, Maastricht, Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Thea Vliet Vlieland
- Orthopaedics, Rehabilitation and Physical Therapy, J11, Leiden University Medical Center, Leiden, Netherlands
| | | | | | | | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Krysia Dziedzic
- Impact Accelerator Unit, School of Medicine, Keele University, Newcastle, UK
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Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. A practice test and selection of a core set of outcome-based quality indicators in Dutch primary care physical therapy for patients with COPD: a cohort study. ERJ Open Res 2022; 8:00008-2022. [PMID: 35983539 PMCID: PMC9379355 DOI: 10.1183/23120541.00008-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Aim To estimate the comparability and discriminability of outcome-based quality indicators by performing a practice test in Dutch physical therapy primary care, and to select a core set of outcome-based quality indicators that are well accepted by physical therapists based on their perceived added value as a quality improvement tool. Methods First, a list of potential quality indicators was defined, followed by determination of the comparability (case-mix adjusted multilevel analysis) and discriminability (intraclass correlation coefficient (ICC)). Second, focus group meetings were conducted with stakeholders (physical therapists and senior researchers) to select a core set of quality indicators. Results Overall, 229 physical therapists from 137 practices provided 2651 treatment episodes. Comparability: in 10 of the 11 case-mix adjusted models, the ICC increased compared with the intercept-only model. Discriminability: the ICC ranged between 0.01 and 0.34, with five of the 11 ICCs being >0.10. The majority of physical therapists in each focus group preferred the inclusion of seven quality indicators in the core set, including three process and four outcome indicators based upon the 6-min walk test (6MWT), the Clinical COPD Questionnaire (CCQ), and the determination of quadriceps strength using a hand-held dynamometer. Conclusion This is the first study to describe the comparability and discriminability of the outcome-based quality indicators selected for patients with COPD treated in primary care physical therapy practices. Future research should focus on increasing data collection in daily practice and on the development of tangible methods to use as the core set of a quality improvement tool. The major finding of this study is that all participants in the focus groups accepted the quality indicators as a quality improvement tool based on their perceived added value and selected a core set of seven outcome-based quality indicators for COPD.https://bit.ly/3NJuQtq
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Angel-Garcia D, Martinez-Nicolas I, Salmeri B, Monot A. Quality of Care Indicators for Hospital Physical Therapy Units: A Systematic Review. Phys Ther 2022; 102:pzab261. [PMID: 34935986 PMCID: PMC8807027 DOI: 10.1093/ptj/pzab261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 06/10/2021] [Accepted: 10/18/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this review was to identify quality indicators described in the literature that may be used as quality measures in hospital physical therapy units. METHODS The following sources were searched for quality indicators or articles: Web of Science, MEDLINE, IBECS, Latin American and Caribbean Health Sciences Literature, Cumulative Index of Nursing and Allied Health, Academic Search Complete, SportDiscus, SciELO, PsychINFO, Consejo Superior de Investigaciones Cientificas, and Scopus databases; the Agency for Healthcare Research and Quality, National Health System Indicator Portal, Joint Commission on Accreditation of Healthcare Organizations, and Organisation for Economic Co-operation and Development websites; and the National Quality Forum's measures inventory tool. Search terms included "quality indicator," "quality measure," "physiotherapy," and "physical therapy." Inclusion criteria were articles written in English, Spanish, French, or Portuguese aimed at measuring the quality of care in hospital physical therapy units. Evidence-based indicators with an explicit formula were extracted by 2 independent reviewers and then classified using the structure-process-outcome model, quality domain, and categories defined by a consensus method. RESULTS Of the 176 articles identified, only 19 met the criteria. From these articles and from the indicator repository searches, 178 clinical care indicators were included in the qualitative synthesis and presented in this paper. Process and outcome measures were prevalent, and 5 out of the 6 quality domains were represented. No efficiency measures were identified. Moreover, structure indicators, equity and accessibility indicators, and indicators in the cardiovascular and circulatory, mental health, pediatrics, and intensive care categories were underrepresented. CONCLUSIONS A broad selection of quality indicators was identified from international resources, which can be used to measure the quality of physical therapy care in hospital units. IMPACT This review identified 178 quality of care indicators that can be used in clinical practice monitoring and quality improvement of hospital physical therapy units. The results highlight a lack of accessibility, equity, and efficiency measures for physical therapy units.
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Affiliation(s)
- Daniel Angel-Garcia
- Department of Physiotherapy, Catholic University of Murcia (UCAM), Guadalupe, Murcia, Spain
| | | | - Bianca Salmeri
- Department of Physiotherapy, Catholic University of Murcia (UCAM), Guadalupe, Murcia, Spain
| | - Alizée Monot
- Department of Physiotherapy, Catholic University of Murcia (UCAM), Guadalupe, Murcia, Spain
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[Development of quality standards for patients with axial spondyloarthritis for use in Germany]. Z Rheumatol 2021; 81:730-743. [PMID: 34379181 DOI: 10.1007/s00393-021-01019-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 11/27/2022]
Abstract
Quality standards (QS) are measurable constructs designed to quantify gaps in care and subsequently to improve quality of care. The Assessment of SpondyloArthritis International Society (ASAS) recently generated and published international QS for the management of patients with axial spondyloarthritis (axSpA) for the first time. The German Society of Rheumatology (DGRh) then decided to translate, review and possibly adopt these standards by a group of experts from different care settings. Against this background, national QS for the management of patients with axSpA for Germany were developed for the first time. The main focus was on feasibility and practical relevance. Ultimately, nine QS were defined with which the quality of care in Germany can and should be measured and improved.
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Meerhoff GA, Verburg AC, Schapendonk RM, Cruijsberg J, Nijhuis-van der Sanden MWG, van Dulmen SA, Van der Wees PJ. Reliability, validity and discriminability of patient reported outcomes for non-specific low back pain in a nationwide physical therapy registry: A retrospective observational cohort study. PLoS One 2021; 16:e0251892. [PMID: 34081704 PMCID: PMC8174721 DOI: 10.1371/journal.pone.0251892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A national clinical registry was established in the Netherlands containing data directly sampled from electronic health record systems of physical therapists (PTs). This registry aims to evaluate the potential of patient reported outcome measures (PROMs) to develop quality indicators (QIs) in physical therapy care. PURPOSE To test to what extent the collected PROM data are reliable, valid and discriminatory between practices in measuring outcomes of patients with non-specific low back pain (NSLBP). METHODS In this retrospective cohort study 865 PT practices with 6,560 PTs voluntarily collected PROM data of patients with NSLBP, using the Quebec Back Pain Disability Scale (QBPDS), the Numeric Pain Rating Scale (NPRS) and the Patient Specific Functioning Scale (PSFS). Reliability was determined by analysing the completeness of the dataset, the comparability by using national reference data, and through checking selection bias in the included patients. Validity was tested using the known-groups contrast between patients with (sub)acute vs. chronic NSLBP. To determine discriminative ability of outcomes between PT practices, case-mix corrected hierarchical multilevel analyses were performed. RESULTS Reliability was sufficient by confirming fifteen of the sixteen hypotheses: 59% of all patients opted in for data analysis, 42% of these included patients showed repeated measurement, comparing with reference data and potential selection bias showed < 5% between group differences, while differences between (sub)acute and chronic NSLB-groups were significantly larger than 5% (less treatment sessions, lager differences in outcomes in (sub)acute NSLB patients). In addition, all nine adjusted hierarchical multilevel models confirm that the collected dataset on outcomes in PT care is able to discriminate between practices using PROM results of patients with NSLBP (ICC-scores range 0.11-0.21). LIMITATIONS Although we have shown the reliability, validity and discriminative ability of the dataset in the quest to develop QIs, we are aware that reducing missing values in patient records and the selective participation of PTs that belong to the innovators needs attention in the next stages of implementation to avoid bias in the results. CONCLUSION PROMs of patients with NSLBP collected in the national clinical registry of KNGF are reliable, valid and able to discriminate between primary care PT practices.
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Affiliation(s)
- Guus A Meerhoff
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
- Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, The Netherlands
| | - Arie C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Renske M Schapendonk
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
- Dutch Health Authority (NZA), Utrecht, The Netherlands
| | - Juliette Cruijsberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | | | - Simone A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Philip J Van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Seo MR, Kim G, Moon KW, Sung YK, Yoo JJ, Yoon CH, Lee EB, Lee J, Kang EH, Kim H, Park EJ, Uhm WS, Lee MS, Lee SW, Choi BY, Hong SJ, Baek HJ. Quality Indicators for Evaluating the Health Care of Patients with Rheumatoid Arthritis: a Korean Expert Consensus. J Korean Med Sci 2021; 36:e109. [PMID: 33942576 PMCID: PMC8093604 DOI: 10.3346/jkms.2021.36.e109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/22/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA. METHODS Preliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method. RESULTS Fourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities, including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse. CONCLUSION These QIs can be used to assess and improve the quality of health care for patients with RA.
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Affiliation(s)
- Mi Ryoung Seo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Gunwoo Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Ki Won Moon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yoon Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jong Jin Yoo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chong Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Bong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyungjin Kim
- Department of Medical Humanities, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Park
- Division of Rheumatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Wan Sik Uhm
- Uhm's Hanyang Rheumatism Clinic, Seoul, Korea
| | - Myeung Su Lee
- Division of Rheumatology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | | | - Byoong Yong Choi
- Department of Internal Medicine, Seoul Medical Center, Seoul Metropolitan Government, Seoul, Korea
| | - Seung Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. Patient-Reported Outcome-Based Quality Indicators in Dutch Primary Care Physical Therapy for Patients With Nonspecific Low Back Pain: A Cohort Study. Phys Ther 2021; 101:6258995. [PMID: 33929546 PMCID: PMC8336590 DOI: 10.1093/ptj/pzab118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/13/2021] [Accepted: 04/07/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to define and select a core set of outcome-based quality indicators, accepted by stakeholders on usability and perceived added value as a quality improvement tool, and to formulate recommendations for the next implementation step. METHODS In phase 1, 15 potential quality indicators were defined for patient-reported outcome measures and associated domains, namely the Numeric Pain Rating Scale (NPRS) for pain intensity, the Patient Specific Functioning Scale (PSFS) for physical activity, the Quebec Back Pain Disability Scale for physical functioning, and the Global Perceived Effect-Dutch Version for perceived effect. Their comparability and discriminatory characteristics were described using cohort data. In phase 2, a core set of quality indicators was selected based on consensus among stakeholders in focus group meetings. RESULTS In total, 65,815 completed treatment episodes for patients with nonspecific low back pain were provided by 1009 physical therapists from 219 physical therapist practices. The discriminability between physical therapists of all potential 15 quality indicators was adequate, with intraclass correlation coefficients between 0.08 and 0.30. Stakeholders selected a final core set of 6 quality indicators: 2 process indicators (the routine measurement of NPRS and the PSFS) and 4 outcome indicators (pretreatment and posttreatment change scores for the NPRS, PSFS, Quebec Back Pain Disability Scale, and the minimal clinically important difference of the Global Perceived Effect-Dutch Version). CONCLUSION This study described and selected a core set of outcome-based quality indicators for physical therapy in patients with nonspecific low back pain. The set was accepted by stakeholders for having added value for daily practice in physical therapy primary care and was found useful for quality improvement initiatives. Further studies need to focus on improvement of using the core set of outcome-based quality indicators as a quality monitoring and evaluation instrument. IMPACT Patient-reported outcome-based quality indicators developed from routinely collected clinical data are promising for use in quality improvement in daily practice.
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Affiliation(s)
- Arie C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands,Address all correspondence to Dr Verburg at:
| | - Simone A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Henri Kiers
- Institute of Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands,Association for Quality in Physical Therapy (SKF), Zwolle, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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11
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Åkesson KE, Buchbinder R, Nordin M, Hurley MV, Overgaard S, Chang LY, Yang RS, Chan DC, Dahlberg L, Nero H, Woolf A. Advances in delivery of health care for MSK conditions. Best Pract Res Clin Rheumatol 2020; 34:101597. [DOI: 10.1016/j.berh.2020.101597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Zanetti A, Scirè CA, Argnani L, Carrara G, Zambon A. Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology. BMJ Open 2020; 10:e038295. [PMID: 32994247 PMCID: PMC7526308 DOI: 10.1136/bmjopen-2020-038295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the adherence to quality of care indicators in early rheumatoid arthritis (RA) and to evaluate its impact on the risk of hospitalisation in a real-world setting. DESIGN Retrospective cohort study. SETTING Patients with early-onset RA identified from healthcare regional administrative databases by means of a validated algorithm between 2006 and 2012 in the Lombardy region (Italy). PARTICIPANTS The study cohort included 14 203 early-onset RA (71% female, mean age 60 years). OUTCOME MEASURES For each patient, a summary adherence score was calculated starting from the compliance to six quality indicators: (1-2) methotrexate or sulfasalazine or leflunomide with/without glucocorticoids, (3-4) other disease-modifying antirheumatic drugs (DMARDs) with/without glucocorticoids, (5) early interruption of glucocorticoids, (6) early clinical assessment.The relationship between low, intermediate and high categories of the summary score and the 12-month risk of hospitalisation for all causes and for RA was assessed. RESULTS During a follow-up of 1 year, 2609 hospitalisations occurred, of which 704 were for RA (main or secondary diagnosis) and 252 primarily for RA. In a 7-year period (2006-2012), early DMARDs and timely clinical monitoring treatment increased (from 52% to 62% p trend <0.001 and from 25% to 30% p trend 0.009, respectively).Intermediate and high summary adherence score categories (compared with the low category) were related significantly with a lower risk of hospitalisation (adjusted HR 0.85 (95% CI 0.77 to 0.93), p<0.001 and HR 0.76 (95% CI 0.69 to 0.84), p<0.001, respectively). Among the indicators of the adherence score, early DMARD prescription showed the strongest positive impact, while long-term use of glucocorticoids was the worst negative one. CONCLUSION In early RA, adherence to quality standards of care is associated with a lower risk of hospitalisation. Future interventions to improve the adherence to quality standards of care in this setting should decrease the risk of hospitalisation with a significant impact on individual and population health.
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Affiliation(s)
- Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
- Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Lombardy, Italy
| | | | - Lisa Argnani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Antonella Zambon
- Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Lombardy, Italy
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13
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Sanz Sanz J, Beltrán E, Díaz-Miguel Pérez MC, Fernández-Carballido C, Galíndez E, García Porrua C, Gratacós J, Medina J, Queiro R, Ramírez J, Reina D, Rodríguez Lozano C, Rodríguez Martínez FJ, Rubio E, Veroz R. Norma de calidad para el manejo del paciente con artritis psoriásica: proyecto QUANTUM. ACTA ACUST UNITED AC 2020; 16:203-215. [DOI: 10.1016/j.reuma.2018.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/12/2018] [Accepted: 06/26/2018] [Indexed: 12/27/2022]
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Kiltz U, Landewé RBM, van der Heijde D, Rudwaleit M, Weisman MH, Akkoc N, Boonen A, Brandt J, Carron P, Dougados M, Gossec L, Jongkees M, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compán V, Niederman K, Sampaio-Barros PD, Slobodin G, Van den Bosch FE, van Tubergen A, van Weely S, Wiek D, Braun J. Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis. Ann Rheum Dis 2020; 79:193-201. [PMID: 31604704 PMCID: PMC7025729 DOI: 10.1136/annrheumdis-2019-216034] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/26/2019] [Accepted: 09/28/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The Assessment of SpondyloArthritis International Society (ASAS) aimed to develop a set of quality standards (QS) to help improve the quality of healthcare provided to adult patients affected by axial spondyloarthritis (axSpA) worldwide. METHODS An ASAS task force developed a set of QS using a stepwise approach. First, key areas for quality improvement were identified, discussed, rated and agreed on. Thereafter, areas were prioritised and statements for the most important key areas were phrased on consensus. Appropriate quality measures were defined to allow quantification of the QS at the community level. RESULTS The ASAS task force, consisting of 20 rheumatologists, two physiotherapists and two patients, selected and proposed 34 potential key areas for quality improvement which were then commented by 140 ASAS members and patients. Within that process three new key areas came up, which led to a re-evaluation of all 37 key areas by 120 ASAS members and patients. Five key areas were identified as most important to determine quality of care: referral including rapid access, rheumatology assessment, treatment, education/self-management and comorbidities. Finally, nine QS were agreed on and endorsed by the whole ASAS membership. CONCLUSIONS ASAS successfully developed the first set of QS to help improving healthcare for adult patients with axSpA. Even though it may currently not be realistic to achieve the QS in all healthcare systems, they provide high-quality of care framework for patients with axSpA that should be aimed for.
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Affiliation(s)
- Uta Kiltz
- Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | - Robert B M Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands
- Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | | | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Michael H Weisman
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, Los Angeles, California, USA
| | - Nurullah Akkoc
- Department of Medicine, Division of Rheumatology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Annelies Boonen
- Internal Medicine, Division of Rheumatology, Maastrich University Medical Center, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Jan Brandt
- Rheumatology, Private Practice, Berlin, Germany
| | - Philippe Carron
- Rheumatology, Ghent University Hospital, Ghent, Belgium
- VIB Inflammation Research Center, Ghent, Belgium
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
- INSERM (U1153): Epidémiologie Clinique et Biostatistiques, PRES Sorbonne Paris-Cité, Paris, France
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), UMR S 1136, Sorbonne Universite, Paris, France
- APHP, Rheumatology department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Anna Molto
- INSERM (U1153): Epidémiologie Clinique et Biostatistiques, PRES Sorbonne Paris-Cité, Paris, France
- Rheumatology, Hopital Cochin, paris, Ile de France, France
| | | | - Karin Niederman
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Percival Degrava Sampaio-Barros
- Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Gleb Slobodin
- Department of Internal Medicine A, Bnai Zion Medical Center, Technion, Haifa, Israel
| | - Filip E Van den Bosch
- VIB Inflammation Research Center, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
| | - Astrid van Tubergen
- Internal Medicine, Division of Rheumatology, Maastrich University Medical Center, Maastricht, The Netherlands
| | - Salima van Weely
- Reade, Centre for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
| | | | - Juergen Braun
- Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
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Queiro R, Coto P, Joven B, Rivera R, Navío Marco T, de la Cueva P, Alvarez Vega JL, Narváez Moreno B, Rodriguez Martínez FJ, Pardo Sánchez J, Feced Olmos C, Pujol C, Rodríguez J, Notario J, Pujol Busquets M, García Font M, Galindez E, Pérez Barrio S, Urruticoechea-Arana A, Hergueta M, López Montilla MD, Vélez García-Nieto A, Maceiras F, Rodríguez Pazos L, Rubio Romero E, Rodríguez Fernandez Freire L, Luelmo J, Gratacós J. Estado actual de la atención multidisciplinar para pacientes con artritis psoriásica en España: proyecto NEXUS 2.0. ACTA ACUST UNITED AC 2020; 16:24-31. [DOI: 10.1016/j.reuma.2018.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 12/13/2022]
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Koenders N, van den Heuvel S, Bloemen S, van der Wees PJ, Hoogeboom TJ. Development of a longlist of healthcare quality indicators for physical activity of patients during hospital stay: a modified RAND Delphi study. BMJ Open 2019; 9:e032208. [PMID: 31712346 PMCID: PMC6858236 DOI: 10.1136/bmjopen-2019-032208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To develop a longlist of healthcare quality indicators for the care of hospitalised adults of all ages with (or at risk of) low physical activity during the hospital stay. DESIGN A modified RAND/UCLA Appropriateness Method Delphi study. SETTING AND PARTICIPANTS Participants were physical therapists, nurses and managers working in Dutch university medical centres. METHODS The current study consisted of three phases. Phase I was a systematic literature search for quality indicators and relevant domains. Phase II was a survey among healthcare professionals to collect additional data. Phase III consisted of three consensus rounds. In round 1, experts rated the relevance of the potential indicators online (Delphi). The second round was a face-to-face expert panel meeting managed by an experienced moderator. Acceptability, feasibility and validity of the quality indicators were discussed by the panel members. In round 3, the panel members rated the relevance of the potential indicators that were still under discussion. RESULTS The search retrieved 1556 studies of which 53 studies were assessed full text. Data from 17 studies were included in a first draft longlist of indicators. Eighteen nurses and one physical therapist responded to the survey and added data for a second draft of the longlist. Experts constructed the final longlist of 23 indicators in three consensus rounds. Seven domains were identified: 'Policy', 'Attitude and education', 'Equipment and support', 'Evaluation', 'Information', 'Patient-tailored physical activity plan' and 'Outcome measure'. CONCLUSION AND IMPLICATIONS The healthcare quality indicators developed in this study could help to grade, monitor and improve healthcare for hospitalised adults of all ages with (or at risk of) low physical activity during the hospital stay. Future research will focus on the psychometric quality of the indicators and selection of key performance indicators.
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Affiliation(s)
- Niek Koenders
- Department of Rehabilitation-Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stein van den Heuvel
- Department of Rehabilitation-Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shanna Bloemen
- Department of Rehabilitation-Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip J van der Wees
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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17
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Fiorino G, Allocca M, Chaparro M, Coenen S, Fidalgo C, Younge L, Gisbert JP. 'Quality of Care' Standards in Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis 2019; 13:127-137. [PMID: 30423033 DOI: 10.1093/ecco-jcc/jjy140] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inflammatory bowel disease [IBD] includes chronic, disabling and progressive conditions that need a complex approach and management. Although several attempts have been made to standardize the care of IBD patients, no clear definitions of a global 'standard of care' are currently available. METHODS We performed a systematic review of the available literature, searching for all relevant data concerning three main domains of standards of quality of care in IBD patients: structure, process and outcomes. From the literature search, 2394 abstracts were retrieved, and 62 relevant papers were included in the final review. RESULTS Standards of quality of care in IBD include several aspects that can be summarized in three identified domains: structure, process and outcomes. The suggested structure of an IBD Unit includes a multi-disciplinary approach, effective referral processes, improved access using helplines, and departmental guidelines/pathways with identification of measurable quality indicators. Coordinated care models which incorporate a multi-disciplinary approach, structured clinical pathways or processes for the diagnosis, monitoring and treatment of IBD, fast-track recovery from IBD surgery, designated IBD clinics, virtual clinics and telemanagement are currently considered the main standards for process, although supporting data are limited. Several consensus statements on outcomes and quality indicators have been reported, focusing on outcomes in symptoms, function and quality of life restoration, survival and disease control, in addition to effective healthcare utilization. CONCLUSIONS The results of this systematic review can provide the basis for general recommendations for standards of quality of care in IBD.
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Affiliation(s)
- Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Mariangela Allocca
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Maria Chaparro
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Sofie Coenen
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Catarina Fidalgo
- Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal
| | - Lisa Younge
- Barts Health - Royal London Hospital, London, UK
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Abstract
OBJECTIVE All healthcare systems require valid ways to evaluate service delivery. The objective of this study was to identify existing content validated quality indicators (QIs) for responsible use of medicines (RUM) and classify them using multiple frameworks to identify gaps in current quality measurements. DESIGN Systematic review without meta-analysis. SETTING All care settings. SEARCH STRATEGY CINAHL, Embase, Global Health, International Pharmaceutical Abstract, MEDLINE, PubMed and Web of Science databases were searched up to April 2018. An internet search was also conducted. Articles were included if they described medication-related QIs developed using consensus methods. Government agency websites listing QIs for RUM were also included. ANALYSIS Several multidimensional frameworks were selected to assess the scope of QI coverage. These included Donabedian's framework (structure, process and outcome), the Anatomical Therapeutic Chemical (ATC) classification system and a validated classification for causes of drug-related problems (c-DRPs; drug selection, drug form, dose selection, treatment duration, drug use process, logistics, monitoring, adverse drug reactions and others). RESULTS 2431 content validated QIs were identified from 131 articles and 5 websites. Using Donabedian's framework, the majority of QIs were process indicators. Based on the ATC code, the largest number of QIs pertained to medicines for nervous system (ATC code: N), followed by anti-infectives for systemic use (J) and cardiovascular system (C). The most common c-DRPs pertained to 'drug selection', followed by 'monitoring' and 'drug use process'. CONCLUSIONS This study was the first systematic review classifying QIs for RUM using multiple frameworks. The list of the identified QIs can be used as a database for evaluating the achievement of RUM. Although many QIs were identified, this approach allowed for the identification of gaps in quality measurement of RUM. In order to more effectively evaluate the extent to which RUM has been achieved, further development of QIs may be required.
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Affiliation(s)
- Kenji Fujita
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah J Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Gratacós J, Luelmo J, Rodríguez J, Notario J, Marco TN, de la Cueva P, Busquets MP, Font MG, Joven B, Rivera R, Vega JLA, Álvarez AJC, Parera RS, Carrascosa JCR, Martínez FJR, Sánchez JP, Olmos CF, Pujol C, Galindez E, Barrio SP, Arana AU, Hergueta M, Coto P, Queiro R. Standards of care and quality indicators for multidisciplinary care models for psoriatic arthritis in Spain. Rheumatol Int 2018; 38:1115-1124. [PMID: 29417210 DOI: 10.1007/s00296-018-3986-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022]
Abstract
To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.
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Affiliation(s)
- Jordi Gratacós
- Servicio de Reumatología, Rheumatology Department, Hospital universitario Parc Taulí de Sabadell, I3PT, UAB, Parc Taulí, 1 Sabadell, 08208, Barcelona, Spain.
| | - Jesús Luelmo
- Servicio de Dermatología, Hospital universitario Parc Taulí de Sabadell, I3PT, UAB, Barcelona, Spain
| | - Jesús Rodríguez
- Servicio de Reumatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jaume Notario
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Teresa Navío Marco
- Servicio de Reumatología, Universitario el Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Pablo de la Cueva
- Servicio de Dermatología, Universitario el Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Mercè García Font
- Servicio de Dermatología, Hospital Mutua de Terrassa, Barcelona, Spain
| | - Beatriz Joven
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Ricardo Sánchez Parera
- Servicio de Reumatología, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | | | | | - José Pardo Sánchez
- Servicio de Dermatología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Carlos Feced Olmos
- Servicio de Reumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Conrad Pujol
- Servicio de Dermatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eva Galindez
- Servicio de Reumatología, Hospital de Basurto, Bilbao, Bizkaia, Spain
| | | | | | | | - Pablo Coto
- Servicio de dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rubén Queiro
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain
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Cooper M, Rouhi A, Barber CEH. A Systematic Review of Quality Measures for Inflammatory Arthritis. J Rheumatol 2017; 45:274-283. [PMID: 29142026 DOI: 10.3899/jrheum.170157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
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. Measures were abstracted in duplicate and categorized into themes, measure type, and domains of quality. RESULTS Thirteen measurement sets were included from 4 countries (United States, Canada, United Kingdom, Netherlands) and 1 European consortium. They included 10 sets on RA and 1 each for PsA, inflammatory arthritis, and JIA. There were 161 unique individual measures (136 process, 20 structure, and 5 outcome). Major themes included assessment, medications, and comorbidities. Measure development methods were varied, including RAND/University of California, Los Angeles appropriateness methodology, prioritization exercises, or other modified-Delphi methods. Inclusion of patients occurred in 77% of development groups. Discussion of barriers to measurement was infrequent. CONCLUSION Inflammatory arthritis quality measures cover a diversity of themes encompassing process, structure, and outcomes of care across the 6 domains of quality. However, between organizations, measure development is not standardized. Local assessment of measurement feasibility before use outside the original development context is recommended.
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Affiliation(s)
- Matthew Cooper
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada
| | - Azin Rouhi
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada
| | - Claire E H Barber
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada. .,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada.
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Chodara AM, Wattiaux A, Bartels CM. Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches. Curr Rheumatol Rep 2017; 19:16. [PMID: 28361332 DOI: 10.1007/s11926-017-0643-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ᅟ: The increase in cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) is well known; however, appropriate management of this elevated risk in rheumatology clinics is less clear. PURPOSE OF REVIEW By critically reviewing literature published within the past 5 years, we aim to clarify current knowledge and gaps regarding CVD risk management in RA. RECENT FINDINGS We examine recent guidelines, recommendations, and evidence and discuss three approaches: (1) RA-specific management including treat-to-target and medication management, (2) assessment of comprehensive individual risk, and (3) targeting traditional CVD risk factors (hypertension, smoking, hyperlipidemia, diabetes, obesity, and physical inactivity) at a population level. Considering that 75% of US RA visits occur in specialty clinics, further research is needed regarding evidence-based strategies to manage and reduce CVD risk in RA. This review highlights clinical updates including US cardiology and international professional society guidelines, successful evidence-based population approaches from primary care, and novel opportunities in rheumatology care to reduce CVD risk in RA.
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Affiliation(s)
- Ann M Chodara
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Aimée Wattiaux
- Rheumatology Division, Department of Medicine, University of Wisconsin (UW) School of Medicine and Public Health (SMPH), 1685 Highland Ave, Rm 4132, 53705-2281, Madison, WI, USA
| | - Christie M Bartels
- Rheumatology Division, Department of Medicine, University of Wisconsin (UW) School of Medicine and Public Health (SMPH), 1685 Highland Ave, Rm 4132, 53705-2281, Madison, WI, USA.
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22
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Mahmood S, van Oosterhout M, de Jong S, Landewé R, van Riel P, van Tuyl LHD. Evaluating quality of care in rheumatoid arthritis: the patient perspective. RMD Open 2017; 3:e000411. [PMID: 28879044 PMCID: PMC5574435 DOI: 10.1136/rmdopen-2016-000411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sehrash Mahmood
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | | | - Sija de Jong
- Dutch Arthritis Foundation, Amsterdam, The Netherlands
| | - Robert Landewé
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Piet van Riel
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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[Standards of care for people with rheumatoid arthritis in Europe : Translation and comments of the eumusc.net recommendations supported by EULAR performed by a national task force of the professional organisations DGRh and VRA supported by "Deutsche Rheumaliga"]. Z Rheumatol 2017; 75:416-28. [PMID: 27138788 DOI: 10.1007/s00393-016-0059-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In a joint initiative by the boards of the German Society for Rheumatology (DGRh) and the Association of Rheumatology Clinics (VRA) the European "standards of care" for rheumatoid arthritis, recently suggested by the European Musculoskeletal Conditions Surveillance and Information Network (eumusc.net) and supported by the European League Against Rheumatism (EULAR), were translated and annotated. The recommendations include aspects of the management of the disease, actual medical care, and access to information - this includes all types of support people with RA need, and, last but not least communication of the necessary knowledge. Furthermore, health care structures such as the availability of medical staff with relevant expertise are also important.
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24
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Braun J, Bessler F, Lakomek HJ, Rudwaleit M. [International quality indicators in rheumatology. Suggestions for rheumatoid arthritis]. Z Rheumatol 2017; 75:330-7. [PMID: 27003861 DOI: 10.1007/s00393-016-0057-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Quality measurement of medical care has become increasingly important in Germany in recent years. Essentially, three areas can be distinguished: the quality of structure, process and outcome. For the measurement of quality, quality indicators are necessary. The Federal Joint Committee has recently been responsible for defining such quality indicators. Because proposals for quality indicators for the indication for rheumatoid arthritis in have already been published in international rheumatology, we selected and translated the three most important European publications in order to present them to the rheumatology community. The ultimate aim is the initiation of a process for the joint development of quality indicators within the professional association and the two associations in Germany in order to then be able to adequately discuss these with policy-makers.
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Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - F Bessler
- Evangelisches Krankenhaus Hagen-Haspe, Hagen, Deutschland
| | - H-J Lakomek
- Klinik für Rheumatologie, Johannes Wesling Klinikum, Minden, Deutschland
| | - M Rudwaleit
- Klinik für Innere Medizin und Rheumatologie, Klinikum Bielefeld Rosenhöhe, Bielefeld, Deutschland
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25
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Abstract
Zusammenfassung. Die Qualitätssicherung zu Gunsten der Patienten ist im Alltag nicht mehr wegzudenken. Diese Arbeit beschreibt wichtige Aspekte bezüglich Sicherstellung von Standards zur Qualitätssicherung und Qualitätsverbesserung im diagnostischen und interventionellen rheumatologischen Ultraschall in der Schweiz durch die Arbeitsgruppe QIR («Quality in Rheumatology»). Qualitätsindikatoren in der Rheumatologie und Qualitätsstandards in der Arthrosonografie werden hervorgehoben und vorgestellt.
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Affiliation(s)
- Giorgio Tamborrini
- 1 Ultraschall Zentrum Rheumatologie, Basel, Member of the EULAR Network of Imaging Training Centres
- 3 EULAR Study Group on Anatomy for the Image
| | - Christian Marx
- 1 Ultraschall Zentrum Rheumatologie, Basel, Member of the EULAR Network of Imaging Training Centres
| | | | | | - Walter Kaiser
- 5 Rheumatologie Praxis, Thalwil, Präsident der Schweizerischem Gesellschaft für Rheumatologie (SGR)
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26
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Braun J, Schneider M, Lakomek HJ. [Cornerstones of quality assurance in medicine in Germany. Important impulse for the situation in treatment of rheumatism]. Z Rheumatol 2016; 75:203-12. [PMID: 26940558 DOI: 10.1007/s00393-016-0054-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The recently passed German hospital structure act (Krankenhausstrukturgesetz) stresses the immense importance of quality for the medical care of the population. How can inpatient and outpatient treatment in the field of rheumatology be improved and how can this be assessed? A very important basis for such measurement approaches are quality indicators, i.e. parameters that indicate to what degree a certain level of quality has already been reached or is planned to be reached in the future. The work performed by the German Rheumatism Research Center (DRFZ) and the Association of Rheumatological Acute Clinics (VRA) in Germany has already used certain quality indicators and this topic has been recently described elsewhere. International quality indicators have also been published in recent years, all for rheumatoid arthritis (RA), the most prevalent inflammatory rheumatic disease and are the central subject of this article. This overview of proposed instruments for quality assessment in rheumatology is intended to initiate a broad discussion on the subject of quality of rheumatological care in Germany.
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Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - M Schneider
- Rheumatologie, Universität Düsseldorf, Düsseldorf, Deutschland
| | - H-J Lakomek
- Rheumatologie, Johannes Wesling Klinikum, Minden, Deutschland
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27
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Peter WF, Hurkmans EJ, van der Wees PJ, Hendriks EJM, van Bodegom-Vos L, Vliet Vlieland TPM. Healthcare Quality Indicators for Physiotherapy Management in Hip and Knee Osteoarthritis and Rheumatoid Arthritis: A Delphi Study. Musculoskeletal Care 2016; 14:219-232. [PMID: 26799718 DOI: 10.1002/msc.1133] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of the present study was to develop healthcare quality indicators (HCQIs) for the physiotherapy (PT) management of patients with hip or knee osteoarthritis (HKOA) or rheumatoid arthritis (RA) in the Netherlands. METHODS Two multidisciplinary expert panels, including patients, were instituted. A draft HCQI set was derived from recommendations included in two existing Dutch PT guidelines for HKOA and RA. The panels suggested additional topics, after which a Delphi procedure was performed. All propositions were scored for their potential to represent good-quality PT care (score range 0-9). Based on predefined rules, the Delphi panel HCQIs were discussed and selected. Lastly, every indicator was rephrased, resulting in its output consisting of a numerator and denominator, to facilitate comparisons within and among practices. RESULTS After two Delphi rounds, two final sets of 17 HCQI - one for HKOA and one for RA - were composed, both containing 16 process indicators (regarding initial assessment, treatment and evaluation) and one outcome indicator. CONCLUSIONS Two sets of HCQIs for PT management in HKOA and RA were developed for measuring the quality of PT care in daily clinical practice. Each indicator was formulated in a measurable way. Future research should focus on the feasibility of both indicator sets for daily clinical practice.
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Affiliation(s)
- W F Peter
- Department of Orthopaedics, Leiden University Medical Center, Leiden, and the Amsterdam Rehabilitation Research Centre | Reade, Amsterdam, the Netherlands
| | - E J Hurkmans
- Section of Physical Therapy, University of Applied Sciences, FH Campus Wien, Vienna, Austria
| | - P J van der Wees
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, and Centre for Evidence Based Physical therapy, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - E J M Hendriks
- Centre for Evidence Based Physical therapy, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - L van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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28
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Dziedzic KS, French S, Davis AM, Geelhoed E, Porcheret M. Implementation of musculoskeletal Models of Care in primary care settings: Theory, practice, evaluation and outcomes for musculoskeletal health in high-income economies. Best Pract Res Clin Rheumatol 2016; 30:375-397. [DOI: 10.1016/j.berh.2016.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
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Affiliation(s)
- Lilian H D van Tuyl
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center, PO Box 7057 1007 MB, Amsterdam, The Netherlands
| | - Kaleb Michaud
- Department of Medicine, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; National Data Bank for Rheumatic Diseases, 1035 North Emporia, Suite 288, Wichita, KS 67214, USA.
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30
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REAL-PANLAR Project for the Implementation and Accreditation of Centers of Excellence in Rheumatoid Arthritis Throughout Latin America: A Consensus Position Paper From REAL-PANLAR Group on Improvement of Rheumatoid Arthritis Care in Latin America Establishing Centers of Excellence. J Clin Rheumatol 2016; 21:175-80. [PMID: 26010179 PMCID: PMC4450904 DOI: 10.1097/rhu.0000000000000247] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A consensus meeting of representatives of 16 Latin American and Caribbean countries and the REAL-PANLAR group met in the city of Bogota to provide recommendations for improving quality of care of patients with rheumatoid arthritis (RA) in Latin America, defining a minimum standards of care and the concept of center of excellence in RA. METHODS Twenty-two rheumatologists from 16 Latin American countries with a special interest in quality of care in RA participated in the consensus meeting. Two RA Colombian patients and 2 health care excellence advisors were also invited to the meeting. A RAND-modified Delphi procedure of 5 steps was applied to define categories of centers of excellence. During a 1-day meeting, working groups were created in order to discuss and validate the minimum quality-of-care standards for the 3 proposed types of centers of excellence in RA. Positive votes from at least 60% of the attending leaders were required for the approval of each standard. RESULTS Twenty-two opinion leaders from the PANLAR countries and the REAL-PANLAR group participated in the discussion and definition of the standards. One hundred percent of the participants agreed with setting up centers of excellence in RA throughout Latin America. Three types of centers of excellence and its criteria were defined, according to indicators of structure, processes, and outcomes: standard, optimal, and model. The standard level should have basic structure and process indicators, the intermediate or optimal level should accomplish more structure and process indicators, and model level should also fulfill outcome indicators and patient experience. CONCLUSIONS This is the first Latin American effort to standardize and harmonize the treatment provided to RA patients and to establish centers of excellence that would offer to RA patients acceptable clinical results and high levels of safety.
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31
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Wahl ER, Yazdany J. Challenges and Opportunities in Using Patient-reported Outcomes in Quality Measurement in Rheumatology. Rheum Dis Clin North Am 2016; 42:363-75. [PMID: 27133495 DOI: 10.1016/j.rdc.2016.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Use of patient-reported outcome measures (PROs) in rheumatology research is widespread, but use of PRO data to evaluate the quality of rheumatologic care delivered is less well established. This article reviews the use of PROs in assessing health care quality, and highlights challenges and opportunities specific to their use in rheumatology quality measurement. It first explores other countries' experiences collecting and evaluating national PRO data to assess quality of care. It describes the current use of PROs as quality measures in rheumatology, and frames an agenda for future work supporting development of meaningful quality measures based on PROs.
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Affiliation(s)
- Elizabeth R Wahl
- VA Quality Scholars Program, Division of Rheumatology, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, Building 1, Room 207-1, San Francisco, CA 94121, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Internal Medicine, University of California, San Francisco, 1001 Potrero Avenue, Building SFGH 30, Room 3301, Box 0811, San Francisco, CA 94110, USA.
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32
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Barber CE, Marshall DA, Mosher DP, Akhavan P, Tucker L, Houghton K, Batthish M, Levy DM, Schmeling H, Ellsworth J, Tibollo H, Grant S, Khodyakov D, Lacaille D. Development of System-level Performance Measures for Evaluation of Models of Care for Inflammatory Arthritis in Canada. J Rheumatol 2016; 43:530-40. [DOI: 10.3899/jrheum.150839] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2015] [Indexed: 12/21/2022]
Abstract
Objective.To develop system-level performance measures for evaluating the care of patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis.Methods.This study involved several methodological phases. Over multiple rounds, various participants were asked to help define a set of candidate measurement themes. A systematic search was conducted of existing guidelines and measures. A set of 6 performance measures was defined and presented to 50 people, including patients with IA, rheumatologists, allied health professionals, and researchers using a 3-round, online, modified Delphi process. Participants rated the validity, feasibility, relevance, and likelihood of use of the measures. Measures with median ratings ≥ 7 for validity and relevance were included in the final set.Results.Six performance measures were developed evaluating the following aspects of care, with each measure being applied separately for each type of IA except where specified: waiting times for rheumatology consultation for patients with new onset IA, percentage of patients with IA seen by a rheumatologist, percentage of patients with IA seen in yearly followup by a rheumatologist, percentage of patients with RA treated with a disease-modifying antirheumatic drug (DMARD), time to DMARD therapy in RA, and number of rheumatologists per capita.Conclusion.The first set of system-level performance measures for IA care in Canada has been developed with broad input. The measures focus on timely access to care and initiation of appropriate treatment for patients with IA, and are likely to be of interest to other arthritis care systems internationally.
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33
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Mahmood S, Lesuis N, van Tuyl LHD, van Riel P, Landewé R. Quality in rheumatoid arthritis care. Best Pract Res Clin Rheumatol 2015; 29:664-79. [PMID: 26697773 DOI: 10.1016/j.berh.2015.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 11/17/2022]
Abstract
While most rheumatology practices are characterized by strong commitment to quality of care and continuous improvement to limit disability and optimize quality of life for patients and their families, the actual step toward improvement is often difficult. This is because there are still barriers to be addressed and facilitators to be captured before a satisfying and cost-effective practice management is installed. Therefore, this review aims to assist practicing rheumatologists with quality improvement of their daily practice, focusing on care for rheumatoid arthritis (RA) patients. First we define quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge". Often quality is determined by the interplay between structure, processes, and outcomes of care, which is also reflected in the corresponding indicators to measure quality of care. Next, a brief overview is given of the current treatment strategies used in RA, focusing on the tight control strategy, since this strategy forms the basis of international treatment guidelines. Adherence to tight control strategies leads, also in daily practice, to better outcomes in patients with regard to disease control, functional status, and work productivity. Despite evidence in favor of tight control strategies, adherence in daily practice is often challenging. Therefore, the next part of the review focuses on possible barriers and facilitators of adherence, and potential interventions to improve quality of care. Many different barriers and facilitators are known and targeting these can be effective in changing care, but these effects are rather small to moderate. With regard to RA, few studies have tried to improve care, such as a study aiming to increase the number of disease activity measures done by a combination of education and feedback. Two out of the three studies showed markedly positive effects of their interventions, suggesting that change is possible. Finally, a simple step-by-step plan is described, which could be used by rheumatologists in daily practice wanting to improve their RA patient care.
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Affiliation(s)
- Sehrash Mahmood
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Department of Rheumatology, Room ZH 3A-58, De boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - Nienke Lesuis
- Sint Maartenskliniek, Department of Rheumatology, Hengstdal 3, 6500, GM, Nijmegen, The Netherlands.
| | - Lilian H D van Tuyl
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Department of Rheumatology, Room ZH 3A-56, De boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - Piet van Riel
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Robert Landewé
- Amsterdam Rheumatology and Immunology Center, Academic Medical Center, Meibergdreef 9, The Netherlands.
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Strand V, Wright GC, Bergman MJ, Tambiah J, Taylor PC. Patient Expectations and Perceptions of Goal-setting Strategies for Disease Management in Rheumatoid Arthritis. J Rheumatol 2015; 42:2046-54. [PMID: 26233504 DOI: 10.3899/jrheum.140976] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify how patients perceive the broad effect of active rheumatoid arthritis (RA) on their daily lives and indicate how RA disease management could benefit from the inclusion of individual goal-setting strategies. METHODS Two multinational surveys were completed by patients with RA. The "Good Days Fast" survey was conducted to explore the effect of disease on the daily lives and relationships of women with RA. The "Getting to Your Destination Faster" survey examined RA patients' treatment expectations and goal-setting practices. RESULTS Respondents from all countries agreed that RA had a substantial negative effect on many aspects of their lives (work productivity, daily routines, participation in social and leisure activities) and emotional well-being (loss of self-confidence, feelings of detachment, isolation). Daily pain was a paramount issue, and being pain- and fatigue-free was considered the main indicator of a "good day." Setting personal, social, and treatment goals, as well as monitoring disease progress to achieve these, was considered very beneficial by patients with RA, but discussion of treatment goals seldom appeared to be a part of medical appointments. CONCLUSION Many patients with RA feel unable to communicate their disease burden and treatment goals, which are critically important to them, to their healthcare provider (HCP). Insights gained from these 2 surveys should help to guide patients and HCP to better focus upon mutually defined goals for continued improvement of management and achievement of optimal care in RA.
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Affiliation(s)
- Vibeke Strand
- From Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, CA; New York University Langone Medical Center, New York, NY; Drexel University College of Medicine, Philadelphia, PA; UCB Pharma, Smyrna, GA, USA; Kennedy Institute of Rheumatology, Oxford, UK.V. Strand, MD, FACP, FACR, Biopharmaceutical Consultant; Adjunct Professor, Division of Immunology/Rheumatology, Stanford University School of Medicine; G.C. Wright, MD, New York University Langone Medical Center; M.J. Bergman, MD, Drexel University College of Medicine; J. Tambiah, MD, UCB Pharma; P.C. Taylor, MD, Kennedy Institute of Rheumatology.
| | - Grace C Wright
- From Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, CA; New York University Langone Medical Center, New York, NY; Drexel University College of Medicine, Philadelphia, PA; UCB Pharma, Smyrna, GA, USA; Kennedy Institute of Rheumatology, Oxford, UK.V. Strand, MD, FACP, FACR, Biopharmaceutical Consultant; Adjunct Professor, Division of Immunology/Rheumatology, Stanford University School of Medicine; G.C. Wright, MD, New York University Langone Medical Center; M.J. Bergman, MD, Drexel University College of Medicine; J. Tambiah, MD, UCB Pharma; P.C. Taylor, MD, Kennedy Institute of Rheumatology
| | - Martin J Bergman
- From Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, CA; New York University Langone Medical Center, New York, NY; Drexel University College of Medicine, Philadelphia, PA; UCB Pharma, Smyrna, GA, USA; Kennedy Institute of Rheumatology, Oxford, UK.V. Strand, MD, FACP, FACR, Biopharmaceutical Consultant; Adjunct Professor, Division of Immunology/Rheumatology, Stanford University School of Medicine; G.C. Wright, MD, New York University Langone Medical Center; M.J. Bergman, MD, Drexel University College of Medicine; J. Tambiah, MD, UCB Pharma; P.C. Taylor, MD, Kennedy Institute of Rheumatology
| | - Jeyanesh Tambiah
- From Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, CA; New York University Langone Medical Center, New York, NY; Drexel University College of Medicine, Philadelphia, PA; UCB Pharma, Smyrna, GA, USA; Kennedy Institute of Rheumatology, Oxford, UK.V. Strand, MD, FACP, FACR, Biopharmaceutical Consultant; Adjunct Professor, Division of Immunology/Rheumatology, Stanford University School of Medicine; G.C. Wright, MD, New York University Langone Medical Center; M.J. Bergman, MD, Drexel University College of Medicine; J. Tambiah, MD, UCB Pharma; P.C. Taylor, MD, Kennedy Institute of Rheumatology
| | - Peter C Taylor
- From Division of Immunology/Rheumatology, Stanford University School of Medicine, Stanford, CA; New York University Langone Medical Center, New York, NY; Drexel University College of Medicine, Philadelphia, PA; UCB Pharma, Smyrna, GA, USA; Kennedy Institute of Rheumatology, Oxford, UK.V. Strand, MD, FACP, FACR, Biopharmaceutical Consultant; Adjunct Professor, Division of Immunology/Rheumatology, Stanford University School of Medicine; G.C. Wright, MD, New York University Langone Medical Center; M.J. Bergman, MD, Drexel University College of Medicine; J. Tambiah, MD, UCB Pharma; P.C. Taylor, MD, Kennedy Institute of Rheumatology
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Stoffer MA, Smolen JS, Woolf A, Ambrozic A, Berghea F, Boonen A, Bosworth A, Carmona L, Dougados M, de Wit M, Erwin J, Fialka-Moser V, Ionescu R, Keenan AM, Loza E, Moe RH, Greiff R, Olejnik P, Petersson IF, Rat AC, Rozman B, Strömbeck B, Tanner L, Uhlig T, Vlieland TPMV, Stamm TA. Development of patient-centred standards of care for osteoarthritis in Europe: the eumusc.net-project. Ann Rheum Dis 2015; 74:1145-9. [PMID: 25416720 PMCID: PMC4431331 DOI: 10.1136/annrheumdis-2014-206176] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/06/2014] [Accepted: 09/20/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The eumusc.net project is an initiative founded by the European Community and the European League Against Rheumatism. One aim of the project was to facilitate equal standards for musculoskeletal health across Europe. The aim of this work-package was to develop patient-centred and consensus based standards of care (SOC) for osteoarthritis (OA), which should be available in a professional and a patient version. METHODS A systematic review concerning guidelines dealing with OA was conducted. Furthermore, experts in musculoskeletal diseases were contacted to ensure that 'grey' literature was not excluded. Documents that fulfilled predefined inclusion/exclusion criteria were included and all interventions for OA were extracted and categorised. Based on this list of interventions, a three round Delphi exercise with an international and multidisciplinary expert panel, including patient research partners, was performed to achieve expert consensus. RESULTS Six documents were included and used for further analysis. Out of them, 46 interventions have been extracted and 10 consensus based SOC were formulated. In addition, a patient version, written in a lay-understandable wording and in the format of checklist questions was developed. An example is SOC 5: "People with OA should achieve optimal pain control using pharmacological and non-pharmacological means." The matching patient-centred checklist question reads: "Do I know how to control pain associated with OA?" CONCLUSIONS The SOC for OA will be available in the 23 languages of the European Union to enhance unified information to patients and professionals and to further harmonise the treatment/care of OA within Europe.
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Affiliation(s)
- Michaela A Stoffer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | | | - Ales Ambrozic
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Florian Berghea
- Universitatea de Medicina si Farmacie Carol Davila, Bucharest, Romania
| | - Annelies Boonen
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Maxime Dougados
- Paris Descartes University, Paris, France Department of Rheumatology-Hôpital Cochin. Assistance Publique-Hôpitaux de Paris, Paris, France INSERM (U1153): Clinical Epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | | | | | - Veronika Fialka-Moser
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria
| | - Ruxandra Ionescu
- Universitatea de Medicina si Farmacie Carol Davila, Bucharest, Romania
| | - Anne-Maree Keenan
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | | | - Rikke H Moe
- National Advisory Unit on Rehabilitation in Rheumatology (NKRR), Oslo, Norway
| | - Rolf Greiff
- Rheumatikerförbundet, Swedish Rheumatism Association, Stockholm, Sweden
| | | | - Ingemar F Petersson
- Orthopedics and Rheumatology, Clinical Sciences, Lund University, Lund, Sweden
| | - Anne-Christine Rat
- Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, Nancy, France
| | - Blaz Rozman
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Britta Strömbeck
- Orthopedics and Rheumatology, Clinical Sciences, Lund University, Lund, Sweden
| | | | - Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology (NKRR), Oslo, Norway
| | | | - Tanja A Stamm
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
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Navarro-Compán V, Smolen JS, Huizinga TWJ, Landewé R, Ferraccioli G, da Silva JAP, Moots RJ, Kay J, van der Heijde D. Quality indicators in rheumatoid arthritis: results from the METEOR database. Rheumatology (Oxford) 2015; 54:1630-9. [DOI: 10.1093/rheumatology/kev108] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Indexed: 11/13/2022] Open
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Ugarte-Gil MF, Silvestre AMR, Pons-Estel BA. Access to an optimal treatment. Current situation. Clin Rheumatol 2015; 34 Suppl 1:S59-66. [PMID: 26188617 PMCID: PMC4617843 DOI: 10.1007/s10067-015-3018-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/10/2015] [Accepted: 05/17/2015] [Indexed: 12/03/2022]
Abstract
Access to an optimal treatment is determined by several factors, like availability, pricing/funding, and acceptability. In Latin America (LA), one of the regions with more disparities particularly on healthcare in the world, access is affected by other factors, including socio-demographic factors like poverty, living in rural regions, and/or health coverage. Regarding rheumatoid arthritis (RA), an inadequate access to specialists leads to diagnosis and treatment delays diminishing the probability of remission or control. Unfortunately, in almost every LA country, there are cities with more than 100,000 inhabitants without rheumatologists; furthermore, a primary care reference system is present in only about half the countries. In the public health system, coverage of biologic disease-modifying antirheumatic drugs occurs for less than 10 % of the patients in about half of the countries. Also, as healthcare providers based their funding decisions mainly in direct costs instead of on patient-centered healthcare quality indicators, access to new drugs is more complicated in this region than in high-income countries. More accurate epidemiological data from LA need to be obtained in order to improve the management of patients with rheumatic diseases in general and RA in particular.
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Affiliation(s)
- Manuel F Ugarte-Gil
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
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Woolf AD, Gabriel S. Overcoming challenges in order to improve the management of rheumatic and musculoskeletal diseases across the globe. Clin Rheumatol 2015; 34:815-7. [PMID: 25700667 DOI: 10.1007/s10067-015-2862-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Anthony D Woolf
- Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, University of Plymouth Peninsula College of Medicine and Dentistry, Plymouth, England, UK,
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Barber CEH, Smith A, Esdaile JM, Barnabe C, Martin LO, Faris P, Hazlewood G, Noormohamed R, Alvarez N, Mancini GBJ, Lacaille D, Keeling S, Aviña-Zubieta JA, Marshall D. Best Practices for Cardiovascular Disease Prevention in Rheumatoid Arthritis: A Systematic Review of Guideline Recommendations and Quality Indicators. Arthritis Care Res (Hoboken) 2015; 67:169-79. [DOI: 10.1002/acr.22419] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/22/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Claire E. H. Barber
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | - Alexa Smith
- Dalhousie University, Halifax; Nova Scotia Canada
| | - John M. Esdaile
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | - Cheryl Barnabe
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | | | - Peter Faris
- University of Calgary and Alberta Health Services, Calgary; Alberta Canada
| | - Glen Hazlewood
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | | | - Nanette Alvarez
- University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary; Alberta Canada
| | | | - Diane Lacaille
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | | | - J. Antonio Aviña-Zubieta
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | - Deborah Marshall
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
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Yeh JJ, Wang YC, Sung FC, Kao CH. Rheumatoid arthritis increases the risk of nontuberculosis mycobacterial disease and active pulmonary tuberculosis. PLoS One 2014; 9:e110922. [PMID: 25337995 PMCID: PMC4206451 DOI: 10.1371/journal.pone.0110922] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/23/2014] [Indexed: 01/01/2023] Open
Abstract
Background Few studies have examined the association of rheumatoid arthritis (RA) with nontuberculosis mycobacterium (NTM) disease and pulmonary tuberculosis (PTB). Methods We identified 29 131 patients with RA from the catastrophic illness registry who were diagnosed from 1998–2008; 116 524 patients without RA from inpatient data files were randomly frequency matched according to sex, age, and index year and used as a comparison group. Both groups were followed-up until the end of 2010 to measure the incidence of NTM disease and active PTB. We analyzed the risk of NTM disease and active PTB using the Cox proportional hazards regression models, controlling for sex, age, and Charlson comorbidity index (CCI). Results The incidence of NTM disease was 4.22 times greater in the RA group than in the non-RA group (1.91 vs 0.45 per 10,000 person-years). The incidence of PTB was 2.99 times greater in the RA group than in the non-RA group (25.3 vs 8.46 per 10,000 person-years). After adjusting for age, sex, and CCI, the adjusted hazard ratios (HRs) of NTM disease and active PTB for the RA group were 4.17 (95% CI = 2.61–6.65) and 2.87 (95% CI = 2.55–3.23), respectively, compared with the non-RA group. In the first 2 years of follow-up, the RA group yielded corresponding adjusted HRs of 4.98 and 3.39 compared with the non-RA group. The follow-up time-specific RA group to the non-RA group HR of both the NTM disease and active PTB varied. Conclusion This study can serve as a reference for clinical physicians to increase awareness regarding the detection of NTM disease and active PTB in RA patients among the any stage of the clinical course even without CCI.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Internal Medicine and Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Meiho University, Pingtung, Taiwan
| | - Yu-Chiao Wang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- College of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease which, if left untreated, leads to functional disability, pain, reduced health-related quality of life and premature mortality. Between 0.5% and 1% of the population are affected worldwide, and between 25 and 50 new cases evolve in a population of 100,000. Practically all patients with RA require initiation with disease-modifying antirheumatic treatment to retard or stop progression, control disease manifestations and reduce the disease burden. If disease course is monitored with adjustment of medication, lifestyle factors, and exercise, as well as physical activity levels, co-morbidities may be prevented in the course of RA. During the last decade, major progress has been made in treating RA through early identification and treatment of the disease. Many patients still experience premature work disability and co-morbidities. For societies, the economic burden of RA is high in terms of direct and indirect costs, including modern drug treatment.
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Affiliation(s)
- Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319, Oslo, Norway,
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Stoffer MA, Smolen JS, Woolf A, Ambrozic A, Bosworth A, Carmona L, Fialka-Moser V, Loza E, Olejnik P, Petersson IF, Uhlig T, Stamm TA. Development of patient-centred standards of care for rheumatoid arthritis in Europe: the eumusc.net project. Ann Rheum Dis 2014; 73:902-5. [PMID: 23921994 PMCID: PMC3995221 DOI: 10.1136/annrheumdis-2013-203743] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/08/2013] [Accepted: 07/14/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The eumusc.net project is a European Union (EU) commission and European League Against Rheumatism (EULAR)funded project that aims to facilitate equal standards for musculoskeletal health in all EU countries. One work-package was to develop evidence-based and patient-centred standards of care (SOC), for rheumatoid arthritis (RA) understandable for patients and professionals across Europe. METHOD A review of documents covering clinical practice 'guidelines' and SOC for RA was conducted. The obtained documents were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) criteria, and all recommended methods to treat RA were extracted. Based on this information, a three-round Delphi exercise was performed including a consensus group meeting of 21 researchers and patient representatives. RESULTS 16 patient-centred SOC were formulated including a lay version in the format of a checklist. An example is SOC 3: 'People with RA should receive a treatment plan developed individually between them and their clinician at each visit.' The corresponding checklist question reads: 'Have I received a treatment plan which includes an explanation of my management, expected goals and outcomes and important contact details?' CONCLUSIONS The SOC for RA will be available in all 23 official European languages and contribute to more unified treatment approaches in Europe.
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Affiliation(s)
- Michaela A Stoffer
- Internal Medicine III, Division of Rheumatology, Medizinische Universität Wien, , Vienna, Austria
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Quach P, Nguyen GC, Benchimol EI. Quality improvement in pediatric inflammatory bowel disease: Moving forward to improve outcomes. World J Gastroenterol 2013; 19:6367-6374. [PMID: 24151355 PMCID: PMC3801307 DOI: 10.3748/wjg.v19.i38.6367] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/12/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
In recent years, pediatric health care has embraced the concept of quality improvement to improve patient outcomes. As quality improvement efforts are implemented, network collaboration (where multiple centers and practices implement standardized programs) is a popular option. In a collaborative network, improvement in the conduct of structural, process and outcome quality measures can lead to improvements in overall health, and benchmarks can be used to assess and compare progress. In this review article, we provided an overview of the quality improvement movement and the role of quality indicators in this movement. We reviewed current quality improvement efforts in pediatric inflammatory bowel disease (IBD), as well as other pediatric chronic illnesses. We discussed the need to standardize the development of quality indicators used in quality improvement networks to assess medical care, and the validation techniques which can be used to ensure that process indicators result in improved outcomes of clinical significance. We aimed to assess current quality improvement efforts in pediatric IBD and other diseases, such as childhood asthma, childhood arthritis, and neonatal health. By doing so, we hope to learn from their successes and failures and to move the field forward for future improvements in the care provided to children with IBD.
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