Background The evaluation of the quality of medical practice and the implementation of corresponding measures to improve it are crucial steps for the development of Rheumatology in Europe. Herein we describe the implementation of a national program, Rheuma Space, aiming at quality improvement in the field of Rheumatology.
Objectives To develop standards for the quality of care accepted by most of the rheumatology services in Portugal.
Methods Quality indicators were obtained through a four-step RAND-modified Delphi methodology. The first step involved a literature search for international benchmarking of quality of care initiatives and indicators, followed by a pre-selection of a initial set of criteria by a task force. The final steps, aiming at defining a smaller set of criteria that could best analyze rheumatology quality of care, encompassed an online Delphi round with all Portuguese rheumatologists and a consensus meeting with a panel of invited experts representing all the Portuguese Rheumatology Departments of the National Health Service.
Results A total of 412 different indicators were collected throughout the first project phase and the final set of 26 quality indicators was defined, within the three Donabedian dimensions of healthcare quality: nine “structure”, eleven “processes” and seven “outcome” indicators. These criteria cover eleven domains of quality of care: personnel and organizational structure, training and research, facilities, equipment and IT, budgeting and financial resources, access to care, clinical records, patient communication, multidisciplinary management, clinical outcomes, and patient and personnel satisfaction.
Conclusions The 26 quality indicators set constitutes the basis for a quality management tool, which is now being implemented in all the Portuguese Rheumatology Departments of the National Health Service. Direct surveys derived from the 26 quality indicators are being applied to health professionals and patients allowing to benchmark departments and to identify strengths and weakness for future improvement. This initiative is deemed to improve the process of care for Portuguese rheumatic patients, thereby ensuring quality standards of structure and process criteria, for a patient-oriented clinical practice, favouring desirable continuous quality improvement on health outcomes.
Acknowledgement Portuguese Rheumatology participating in the online Delphi and all the participants in the expert consensus meeting
Disclosure of Interest None declared
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