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J Rheumatol. 2018 Nov;45(11):1501-1508. doi: 10.3899/jrheum.171284. Epub 2018 Jun 15.

Feasibility of Measurement and Adherence to System Performance Measures for Rheumatoid Arthritis in 5 Models of Care.

Author information

1
From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada. cehbarbe@ucalgary.ca.
2
C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada. cehbarbe@ucalgary.ca.
3
From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.
4
C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada.

Abstract

OBJECTIVE:

To test the feasibility of reporting on 4 national performance measures for patients with rheumatoid arthritis (RA) in 5 different models of care.

METHODS:

The following performance measures were evaluated in 5 models of care: waiting time (WT) to rheumatologist consultation, percentage of patients seen in yearly followup (FU), percentage taking disease-modifying antirheumatic drugs (DMARD), and time to starting DMARD. All models aimed to improve early access and care for patients with RA.

RESULTS:

A number of feasibility issues were encountered in performance measure evaluation because of differences in site data collection and/or the duration of the model of care. For example, while 4/5 programs maintained clinical or research databases, chart reviews were still required to report on WT. Median WT for care in 2015 varied by site between 21 and 75 days. Yearly FU rates could only be calculated in 2 sites (combined owing to small numbers) and varied between 83% and 100%. Percentage of patients taking a DMARD and time to DMARD could be calculated in 3 models, and rates of DMARD use were between 90% and 100%, with median time to DMARD of 0 days in each.

CONCLUSION:

Our review has shown that even in models of care designed to improve access to care and early treatment, data to document improvements are often lacking. Where data were available for measuring, deficits in WT performance were noted for some centers. Our results highlight a need to improve reporting processes to drive quality improvement.

KEYWORDS:

QUALITY INDICATORS; QUALITY OF HEALTHCARE; RHEUMATOID ARTHRITIS

PMID:
29907674
DOI:
10.3899/jrheum.171284

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