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Development of healthcare quality indicators for rheumatoid arthritis in Europe: the project
  1. Ingemar F Petersson1,
  2. Britta Strömbeck1,
  3. Lene Andersen2,
  4. Marco Cimmino3,
  5. Rolf Greiff4,
  6. Estibaliz Loza5,
  7. Carlo Sciré6,
  8. Tanja Stamm7,
  9. Michaela Stoffer7,
  10. Till Uhlig8,
  11. Anthony D Woolf9,
  12. Theodora P M Vliet Vlieland10,
  13. the group
  1. 1Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
  2. 2Danish Society of Rheumatology, Copenhagen, Denmark
  3. 3Dipartimento di Medicina Interna, Clinica Reumatologica, Università degli Studi di Genova, Genova, Italy
  4. 4Swedish Rheumatism Association, Stockholm, Sweden
  5. 5Research Unit, Spanish Society of Rheumatology, Madrid, Spain
  6. 6Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
  7. 7Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
  8. 8National Resource Center for rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  9. 9Department of Rheumatology, Royal Cornwall Hospital, Truro, UK
  10. 102 Department of Orthopaedics, J11, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Professor Ingemar Petersson, Epi-centre Skåne, Skåne University Hospital, Lund University, Lund, SE-223 81, Sweden; Ingemar.petersson{at}


Background ( is a European project supported by the EU and European League Against Rheumatism to improve musculoskeletal care in Europe.

Objective To develop patient-centred healthcare quality indicators (HCQIs) for healthcare provision for rheumatoid arthritis (RA) patients.

Methods Based on a systematic literature search, existing HCQIs for RA were identified and their contents analysed and categorised referring to a list of 16 standards of care developed within the An international expert panel comprising 14 healthcare providers and two patient representatives added topics and during repeated Delphi processes by email ranked the topics and rephrased suggested HCQIs with the preliminary set being established during a second expert group meeting. After an audit process by rheumatology units (including academic centres) in six countries (The Netherlands, Norway, Romania, Italy, Austria and Sweden), a final version of the HCQIs was established.

Results 56 possible topics for HCQIs were processed resulting in a final set of HCQIs for RA (n=14) including two for structure (patient information and calculation of composite scores), 11 for process (eg, access to care, assessments, and pharmacological and non-pharmacological treatments) and one for outcome (effect of treatment on disease activity). They included definitions to be used in clinical practice and also by patients. Further, the numerators and the denominators for each HCQI were defined.

Conclusions A set of 14 patient-centred HCQIs for RA was developed to be used in quality improvement and bench marking in countries across Europe.

  • Rheumatoid Arthritis
  • Quality Indicators
  • Patient perspective
  • Multidisciplinary team-care

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