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THU0610 Rheuma space: standard practice aiming clinical excellence in rheumatology
  1. C Macieira1,
  2. L Cunha-Miranda2,
  3. P Nero3,
  4. P Lucas4,
  5. J Eurico da Fonseca1,5,
  6. J Canas da Silva6,
  7. on behalf of Rheuma Space study group
  1. 1Department of Rheumatology, Centro Hospitalar Lisboa Norte
  2. 2Department of Rheumatology, Instituto Português de Reumatologia
  3. 3Department of Rheumatology, Hospital CUF Descobertas, Lisbon
  4. 4QuintiliesIMS, Porto Salvo
  5. 5Faculdade de Medicina da Universidade de Lisboa, Lisbon
  6. 6Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal


Background The quality of medical care and the implementation of measures to improve it are crucial steps for the development of Rheumatology in Europe. Quality indicators were obtained through a four-step rand-modified Delphi methodology. A final set of 26 quality indicators was defined within Donabedian framework dimensions: 9 “structure”, 11 “processes” and 6 “outcomes” indicators. Herein we describe the second implementation phase of a national program, Rheuma Space (RS), aiming at quality improvement in Rheumatology.

Objectives To develop a quality improvement plan for care provided by Rheumatology Departments (RD). In this second phase we present the results of the RD evaluation.

Methods A measurement scale on quality/excellence thresholds was developed for each of the 26 criteria. Eight RD participated in the project and each one set up an Investigation Team of 2–3 members for field criteria measurement and evaluation that required the use of different data sources and focused on the period: 2014 – 1st semester of 2015. After data analysis an individual report was delivered and discussed with each of the 8 RD. Afterwards public presentation and discussion of the results took place.

Results “Structure” was evaluated in terms of personal, training, facilities, equipment and budgeting:

  • RD lack Rheumatology specialists and need fully dedicated nurses

  • Training plans exist in all RD, but physicians allocate few time to research

  • Equipment is appropriate, nonetheless microscopes and computers could be updated

  • Internal contracting is well established and professionals are committed to targets

“Processes” were evaluated in terms of access and medical care, clinical records, physician-patient communication and multidisciplinary patient management:

  • Triage criteria for first appointments should be standardized, despite compliance for “High Priority” patients

  • Follow up could be more frequent, but direct access in emergencies is guaranteed

  • registry is mainly used for patients under biologics and data completion could improve

  • Multidisciplinary care is provided, but patient coverage and specialty diversity can increase.

“Outcomes” were evaluated in terms of clinical outcomes, patient and personal satisfaction:

  • Average working absence is <15days/patient/year, but is much higher in more affected patients

  • Almost 1/3 of patients requested early retirement at a median age >50years

  • Patients are satisfied with provided care and physicians' attitude, but less with RD facilities

  • Professionals are satisfied with working environment, however criticize career related aspects.

Conclusions The 26 quality indicators set the basis of this quality management tool that was applied to 8 Portuguese RD. Strengths and weakness were identified and an individual Department report was elaborated and discussed. Interventions are now being planned based on these results in order to ensure quality standards of structure and process criteria for a patient oriented clinical practice, favouring desirable continuous quality improvement on health outcomes.

Acknowledgements Investigation Teams from the eight Rheumatology Departments that participated in the Rheuma Space Project.

Disclosure of Interest None declared

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