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A model for the development and implementation of a national plan for the optimal management of early spondyloarthritis: the Esperanza Program
  1. Santiago Muñoz-Fernández1,
  2. Loreto Carmona2,
  3. Eduardo Collantes3,4,
  4. Juan Mulero5,6,
  5. M Jesús García-Yébenes7,
  6. Eugenio de Miguel8,
  7. Raquel Almodovar9,
  8. Cristina Fernández-Carballido10,
  9. José Francisco García Llorente11,
  10. Milena Gobbo12,
  11. the Esperanza Group
  1. 1Rheumatology Unit, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
  2. 2Research Unit, Sociedad Española de Reumatología, Madrid, Spain
  3. 3Rheumatology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
  4. 4School of Medicine, Universidad de Córdoba, Córdoba, Spain
  5. 5Rheumatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
  6. 6Universidad Autónoma de Madrid, Madrid, Spain
  7. 7Research Unit, Sociedad Española de Reumatología, Madrid, Spain
  8. 8Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
  9. 9Rheumatology Department, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
  10. 10Rheumatology Unit, Hospital General de Elda, Elda, Spain
  11. 11Rheumatology Department, Hospital de Basurto, Basurto, Spain
  12. 12Research Unit, Sociedad Española de Reumatología, Madrid, Spain
  1. Correspondence to Milena Gobbo, Research Unit, Sociedad Española de Reumatología, Calle Marqués del Duero, 5, 1, 28001 Madrid, Spain; milena.gobbo{at}


Objectives To evaluate the performance of a healthcare programme in early spondyloarthritis (SpA).

Methods Based on previous analyses and expectations of a nominal group, the following were set: (1) minimum standards to create early SpA units; (2) standard operating procedures; and (3) eight performance indicators that can be measured in real time using a web-based platform.

Results At the end of the evaluation of the programme the expected level of performance was achieved in three of the indicators: ‘referral reliability’ (standard (S) >50%, real value (RV) 92%), ‘accessibility’ (S >90%, RV=91%) and ‘duration of first visit’ (S >50%, RV=53%). The performance in the remaining indicators was inferior: ‘success of referral criteria’ (S >50%, RV=28%), ‘clinical reports issued’ (S >90%, RV=25%), ‘feedback guarantee’ (S >85%, RV=2%), ‘missing data’ (S <10%, RV=24%) and ‘frequency of review’ (S >90%, RV=84%). Explanations for the low performance are provided.

Conclusions It is possible to implement a large-scale programme that is measurable.

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  • Funding Pfizer (previously Wyeth) sponsored the Spanish Foundation of Rheumatology to run the Program Esperanza. The sponsor had no role in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication. Researchers were independent from funders. This work was partially supported by RETICS Program, RD08/0075 (RIER) from Instituto de Salud Carlos III (ISCIII), within the VI PN de I+D+I 2008-2011 (FEDER).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the CEIC Hospital Universitario Reína Sofía, Córdoba.

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