Background While innovation and research has provided high quality care, we are largely unable to quantify this increase in quality in clinical practice, while costs are rising to unacceptable levels. As health care facilities are unable to measure their performance (use of different measures), no information is available about quality of care between facilities.
Objectives In order to standardize care processes and to give more insight in the provided care in The Netherlands, the Dutch Quality registry Rheumatoid Arthritis (DQRA) is developed. The rise of the DQRA and selection of quality indicators is described in this abstract.
Methods Stakeholders involved in the development of the DQRA were; rheumatologists, patients and healthcare insurers. All were approached in separate ways:
Rheumatologists: Expert group meetings were held to evaluate the current practice in the represented hospitals and regions. Available quality indicators for rheumatoid arthritis (RA) from the literature were presented and merged into an online survey. Indicators were selected based on their validity, feasibility and importance regarding the quality of rheumatology care. Indicators selected by <30% of rheumatologist were excluded; indicators selected by >70% of rheumatologists were directly included in the set of physician domains (domains are needed to form the actual indicator, e.g. disease activity). Remaining indicators were discussed further during a consensus meeting and were included to the physicians domains.
Patients perspective was assessed by means of a focus group discussion (n=6), combined with an online survey (n=1132). This approach resulted in the patients' perspective regarding quality of rheumatology care.
Healthcare insurers were also approached by means of a focus group discussion (n=6). The physicians' domains and the domains as formed by the patients were presented to representatives of healthcare insurers. This discussion resulted in domains that can be used to select an indicator.
During a final expert group meeting in which all three stakeholders were represented, the final set of domains was discussed and established after final adjustments.
Results The physician domains consist of; tender and swollen joint count (28); acute phase reactant; patient and physician VAS (together forming the disease activity) and drug-treatment. Patient-evaluation of rheumatology care is measured by the following domains; 1) adjusting therapy based on disease activity; 2) insight in the patient's personal life; 3) shared decision making; 4) education about the disease (course); 5) insight into co-morbidities and co-medication).
These domains form the foundations for the development of quality indicators. Indicators will be selected based on the characteristics formed by healthcare insurers; 1) ability to detect quality differences; 2) ability to detect the expediency; 3) clearness; 4) can be standardized and 5) ability to detect the added value of a certain therapy.
Conclusions The DQRA is the first Dutch quality registry with the ambition to comprise all RA patients in the Netherlands. A minimal set of quality domains is formed from the perspectives of three stakeholders. Prospective data from the registry will be used to develop valid and reliable quality indicators (“norms”) that help clinicians to continuously improve their practices.
Disclosure of Interest None declared