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Development of quality indicators for monitoring of the disease course in rheumatoid arthritis
  1. L T C van Hulst1,2,
  2. J Fransen1,
  3. A A den Broeder3,
  4. R Grol2,
  5. P L C M van Riel1,
  6. M E J L Hulscher2
  1. 1Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. 2Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. 3Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
  1. Correspondence to Ms L T C van Hulst, Department of Rheumatology (470), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands; L.vanhulst{at}


Objectives: To suppress rheumatoid arthritis (RA) patients’ disease activity, it should be periodically measured and patients should be treated on the basis of the disease activity outcomes. Insight into the actual care, by using quality indicators, is the first step in achieving optimal care. The objective of this study was to develop a set of quality indicators to evaluate RA disease course monitoring of rheumatologists in daily clinical practice.

Methods: A RAND-modified Delphi method in a five-step procedure was applied: a literature search for quality indicators and recommendations about disease course monitoring; a first questionnaire round; a consensus meeting; a second questionnaire round and drawing up the final set.

Results: The systematic procedure resulted in the development of 18 quality indicators: 10 process, five structure and three outcome indicators that describe seven domains of disease course monitoring: schedule follow-up visits; measure disease activity; functional impairment; structural damage; change medication; preconditions for measuring disease activity and outcome measures in terms of disease activity.

Conclusions: This quality indicator set can be used to assess the quality of disease course monitoring of rheumatologists in daily clinical practice, and to determine for which aspects of disease course monitoring rheumatologists perform well, or where there is room for improvement. This information can be used to improve the quality of disease course monitoring.

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  • ▸ Additional supplemental appendices A, B and C are published online only at

  • Competing interests None.

  • Sponsorship: This study was sponsored by the Dutch Arthritis Association.

  • Provenance and Peer review Not commissioned; externally peer reviewed.