Final set of quality indicators (QIs) for monitoring of the disease course in RA
| Type indicator | QIs per domain | Numerator/denominator descriptions | Support evidence |
| Process | 1. Schedule follow-up visits | ||
| a. A rheumatologist should schedule a follow-up visit with an RA patient within 3 months when remission has not been proved | No of follow-up visits, when remission (DAS28 <2.6) has not been proved in previous visit, within 3 months/total no of follow-up visits when remission (DAS28 <2.6) has not been proved in previous visit | B | |
| b. A follow-up visit between 3 and 6 months should be scheduled with either the rheumatologist or specialised nurse in rheumatology when an RA patient is in remission. A rheumatologist should schedule follow-up visits with an RA patient at least every year when an RA patient is in remission | No of follow-up visits when remission has been proved in previous visit with either the rheumatologist or specialised nurse between 3 and 6 months and yearly with the rheumatologist/total no of follow-up visits when remission has been proved in previous visit | B | |
| 2. Measure disease activity | |||
| a. A rheumatologist or a specialised nurse in rheumatology should measure disease activity at baseline and every follow-up visit with the DAS28 in an RA patient | No of visits with a rheumatologist and/or a specialised nurse where disease activity is measured with the DAS28/total no of visits with the rheumatologist and/or a specialised nurse | B | |
| b. % RA patients with yearly “X” number DAS28 values | No of RA patients with 1-year follow-up with “X” number of DAS28 values/total no of RA patients with 1-year follow-up | B | |
| 3. Measure functional impairment | |||
| a. A rheumatologist or a specialised nurse in rheumatology should measure functional impairment yearly with the HAQ in an RA patient | No of RA patients per year with a measure of functional impairment with the HAQ/total no of RA patients per year | D | |
| 4. Measure structural damage | |||
| a. A rheumatologist should order x rays of hands and forefeet initially and 1 year after RA diagnosis for diagnostics and prognostics | No of patients with recent RA diagnosis in which x rays from hands and forefeet are taken initially (<3 months) and 1 year after diagnosis/total no of patients with recent RA diagnosis | D | |
| b. A rheumatologist should order x rays of hands and forefeet after a period of persistent disease activity if no x rays from hands and feet were taken in the past 12 months | No of RA patients who had a period of persistent disease activity (DAS28 values two consecutive visits >3.2) and no x rays in the past 12 months were taken, with newly taken x rays from hands and forefeet/total no of RA patients who had a period of persistent disease activity (DAS28 values two consecutive visits >3.2) and no x rays in the past 12 months | D | |
| c. A rheumatologist should not order x rays of hands and forefeet if disease activity is moderate or high except if no x rays from hands and feet are taken in the past 12 months | No of RA patients with moderate or high disease activity (DAS28 >3.2) and x rays from hands and forefeet in the past 12 months in which no x rays are taken from hands and forefeet/total no of RA patients with moderate or high disease activity and x rays in the past 12 months | D | |
| 5. Change medication | |||
| a. A rheumatologist should intensify* medication when disease activity is moderate or high and time to response on treatment is fulfilled in an RA patient | No of RA patients’ visits with DAS28 >3.2 and time to response on treatment is fulfilled in which treatment is intensified*/total no of RA patients’ visits with moderate or high disease activity and time to response of treatment is fulfilled | A2 | |
| b. Rheumatologists should change medication on the basis of disease activity (DAS28) except if extra-articular manifestations or comorbidities are hindering in an RA patient | No of RA patients with DAS28 >3.2 and time to response on treatment is fulfilled and no extra-articular manifestations or comorbidities in which treatment is intensified*/total no of RA patients with DAS28 >3.2 and time to response of treatment is fulfilled and no extra-articular manifestations or comorbidities | A2 | |
| Structure | 6. Preconditions for measuring disease activity | ||
| a. Within an outpatient rheumatology clinic a specialised rheumatology nurse should have their own consultations with RA patients | No of outpatient rheumatology clinics in which a specialised rheumatology nurse has their own consultations with RA patients/total no of outpatient rheumatology clinics | D | |
| b. Within an outpatient rheumatology clinic at least one specialised rheumatology nurse should be present to monitor RA patients systematically | No of outpatient rheumatology clinics with at least one specialised rheumatology nurse/total no of outpatient rheumatology clinics | D | |
| c. Within an outpatient rheumatology clinic rheumatologists and | % Rheumatologists with a joint count course in the past 5 years | D | |
| specialised rheumatology nurses need to be sufficiently trained in performing joint counts | % Outpatient rheumatology clinics that offer joint count courses for specialised nurses (and if so how often?) | ||
| % Outpatient clinics that organise yearly a standardisation between nurses and rheumatologists | |||
| d. Within an outpatient rheumatology clinic DAS28 values should be (electronically) documented and to be claimed for all RA patients | No of outpatient rheumatology clinics in which DAS28 values are (electronically) documented and to be claimed/total no of outpatient rheumatology clinics | D | |
| e. Within an outpatient rheumatology clinic DAS28 values need to be determined before RA patients consult with the rheumatologist and should be available during the consult with the rheumatologist | No of outpatient clinics in which DAS28 values are determined before the consult with the rheumatologist and available for the rheumatologist/total no of outpatient clinics | ||
| Outcome | 7. Disease activity | ||
| a. % RA patients with a DAS28 score larger than 5.1 at diagnosis and with a DAS28 of 3.2 or lower after 6 months | No of RA patients with a DAS28 score larger than 5.1 at diagnosis and after 6 months with a DAS28 of 3.2 or lower/total no of RA patients with a DAS28 score larger than 5.1 at diagnosis and followed for 6 months | D | |
| b. % RA patients in remission (DAS28 <2.6) 1 year after diagnosis | No of RA patients 1 year after diagnosis who are in remission (DAS28 <2.6)/total no of RA patients 1 year after diagnosis | D | |
| c. % RA patients in remission (DAS28 <2.6) at a standardised date | No of RA patients at a standardised date who are in remission (DAS28 <2.6)/total no of RA patients at a standardised date | D |
*Adding or a switch to another disease-modifying antirheumatic drug, increasing disease-modifying antirheumatic drug dose, adding corticosteroids (injections) or increasing the dose of corticosteroids. DAS28, disease activity score in 28 joints; HAQ, health assessment questionnaire; RA, rheumatoid arthritis.