Background: There is wide variation in the management of patients with axial spondyloarthritis (axSpA) worldwide with significant unmet needs such as delayed diagnosis and inequity in bMARD prescription.¹ Assessing the quality of care provided to patients with axSpA is important not only to patients and physicians, but also to providers and purchasers of health care. There is no agreed methodology to quantify quality of care but several approaches have been proposed aiming to assess quality in a measurable construct, e.g. quality indicators, performance measures or quality standards. Definition of quality standards (QS) enable society to identify resources and processes which may need to be optimized in patients with axSpA.

Objectives: A major goal of the international organization Assessment of SpondyloArthritis international Society (ASAS) is to improve quality of care and health outcomes in patients with axSpA. Recognized gaps in current care prompted ASAS in 2016 to start developing a quality standard set (ASAS QS) to optimize access, treatment and patient outcomes in axSpA.

Methods: An ASAS task force developed a set of ASAS QS step-wise. First, key areas for quality improvement were proposed, discussed, rated and agreed on. Thereafter, key areas were prioritized and statements for the most important key areas were phrased on consensus. Appropriate tools were selected and measures developed to be able to assess and quantify the quality of care on the community level.

Results: The ASAS task force, consisting of 20 rheumatologists, 2 physiotherapists and 2 patients, selected and proposed 34 potential key areas for quality improvement which were commented by 140 ASAS survey participants (86 physicians, 42 patients). Within that process 3 new key areas came up, which led to a reevaluation of all 37 key areas by 120 participants (86 physicians, 29 patients). Five key areas were identified as most important to determine quality of care: referral including rapid access, monitoring, treatment, education including patient information and comorbidities. On that background, 9 QS were agreed on and finally endorsed by ASAS.

Conclusion: ASAS successfully developed the first QS set for improvement of health care for adult patients with axSpA. All QS are measurable achievable in daily care in an optimized situation and intend to minimize variation in quality of care.

Reference: [1] Nikiphorou E, et al. Inequity in biological DMARD prescription for spondyloarthritis across the globe: results from the ASAS-COMOSPA study. Ann Rheum Dis 2018;77:405–411.

Disclosure of interests: Uta Kiltz Grant/research support from:

AbbVie, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Consultant for: AbbVie, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB.