Background One of the missions of the Spanish Society of Rheumatology (SER) is to provide professionals involved with the necessary tools to ensure a better care for patients suffering from a rheumatic disease. Up to now, there is no benchmark that quantifies the complexity of medical acts in this specialty. Therefore, there is a need to adopt a physician activity scale that would allow assessment of their professional activity and skills regarding patient care.
Objectives To compile a nomeclature of medical, diagnostic, and therapeutic procedures in the field of rheumatology; and to establish a hierarchical classification system according to a complexity index.
Methods A list of care, diagnostic, and therapeutic acts was compiled based on the nomenclature created by Drs Fernandez and Olive. The hierarchical classification system was based on the construction of a complexity index which was calculated by two factors: time of completion and degree of complexity of each act. Time of completion was stated according to the document “Standards of Process Time and Patient Care Quality” by Dr Alonso. The degree of complexity of each rheumatologic act was agreed thanks to a panel of experts using a Delphi technique in two rounds. Subsequently, it was validated against a questionnaire which was sent to the 1144 partners of SER via its web.
Results The total of included acts was 54. The results obtained with the Delphi method tended to show a consensus of opinion (media σ2 - σ1=0.75–1.43=-0.68, media IQR2 – IQR1=0.8–1.9=-1.1). Furthermore, a validation of these results was carried out through a massive survey among the partners of SER. The survey results showed a high degree of agreement (at least 70.0 per cent of the partners agreed or strongly agreed with the complexity of each act).
The degree of complexity in successive visits was 100. In the query section for consultations, the highest scores were obtained by first visit to hospitalized patient (366) and home visit (369). Regarding diagnostic techniques, the highest scores were obtained with biopsies: bone (465), sural nerve (416), and synovial (380). Also worth mentionioning the scores obtained by ultrasound scan (204), capillarioscopy (113) and densitometry (112). Regarding therapeutic techniques, intra-articular injection under sedation in children obtained a score of 388; while intra-articular injection with ultrasound control obtained a score of 163. The clinical report of disability was agreed to have a score of 323, and the expert report obtained a score of 370.
Conclusions This work has made it possible to create a nomenclature of 54 acts in Rheumatology where biopsies (bone, sural nerve, synovial), visits to hospitalized patients, home visits, infiltration under sedation in children, and expert reports are identified as the most complex acts. Musculoskeletal ultrasound is considered twice as complex as a successive visit, capillaroscopy, or bone densitometry. These results will make it possible to improve patient care and establish a solid and agreed foundation to negotiate the provision of public and private services.
Disclosure of Interest None declared
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