Background While practical guidelines and recommendations play an important role in the treatment of RA, rheumatologists often tend to deviate from these guidelines (1). This may result in disparity of quality of care among individual doctors and hospitals. To establish the best possible care, quality measures are needed. These aim to quantify the quality of the delivered care and will form the foundation of quality registries. Standardization of care processes in combination with public reporting of performance (by means of a quality registry) has been suggested to improve quality of care (2).
Objectives To develop feasible quality indicators (QIs), endorsed by the different stakeholders of the Dutch Quality registry Rheumatoid Arthritis (DQRA).
Methods An expert group of 8 rheumatologists, 2 patient representatives and 1 healthcare insurer representative developed a minimal set of QIs via a Delphi-like procedure (3), endorsed by the Dutch Society for Rheumatology. Since October 2015, these QIs have been registered by rheumatologists and rheumatology nurses, once a year in 26 hospitals, along with a patient evaluation questionnaire regarding the received care. To determine whether it is feasible to collect these QIs in daily practice, retrospective data from three hospitals was obtained (hospital A (university), B and C (non-academic)).
Feasibility was determined by evaluation of:
Completeness of registered data (figure 1)
Possibility to calculate disease activity categories (remission, low-high disease activity)
Possibility to calculate changes over time in disease activity categories
Extraction of data regarding (b)DMARD use
Results Selected QIs are:
1. Percentage of patients in a certain disease activity category
2. Percentage of patients using a certain (b)DMARD
3. Patient reported experience with received care
Hospital B provided only data from one year (2014) and was not able to extract data on medication from their electronic record system.
Conclusions The DQRA is the first to incorporate perspectives from three stakeholders (patients, physicians and healthcare insurers) and successfully formed a limited set of QI. Collection of these indicators was feasible in two out of the three participating hospitals and offers insight in differences in provided and perceived care for RA patients.
Mahmood et al. Best Pract Res Clin Rheumatol 2015.
Chassin et al. Health Aff 2002.
Mahmood et al. ARD 2016.
Disclosure of Interest None declared