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Spring 2018 (Volume 28, Number 1)

The First Canadian System-level Performance Measures for Inflammatory Arthritis

By Claire Barber, MD, PhD, FRCPC

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When the Arthritis Alliance of Canada (AAC) developed an approach to Models of Care for inflammatory arthritis (IA) in 2014, a critical component of implementing this approach was evaluation. At the time, there were no existing system-level performance measures for IA care. We therefore embarked on a study to develop a set of performance measures to evaluate models of care for IA at a system level.

Through multiple rounds of an online modified-Delphi process, we gained broad input from 50 arthritis stakeholders including rheumatologists, allied health professionals, persons living with arthritis, and researchers. Participants rated the validity, feasibility, relevance and likelihood of using a proposed set of performance measures, which were identified based on a systematic review of the literature.

Six performance measures emerged for evaluating inflammatory arthritis care:

  • 1) wait times for rheumatology consultation for patients with new onset     IA;
  • 2) percentage of IA patients seen by a rheumatologist;
  • 3) percentage of IA patients seen in yearly follow-up by a rheumatologist;
  • 4) percentage of rheumatoid arthritis patients treated with a disease     modifying anti-rheumatic drug (DMARD);
  • 5) time to DMARD therapy in patients with rheumatoid arthritis;
  • 6) number of rheumatologists per capita.

This constitutes the first set of system-level performance measures for evaluating models of care in IA. These can serve as an aid for health care decision-makers to identify and prioritize areas for improvement, and to measure outcomes of health system changes whose goals are to improve the care of patients with IA.

Dr. Claire Barber, Assistant Professor, Rheumatologist,
University of Calgary, Calgary, AB

Reference:

Barber CE, et al. Development of system-level performance measures for evaluation of models of care for inflammatory arthritis. J Rheumatol 2016; 43:530-40.


Core Clinical Data Set Supports High-quality Care for RA Patients in Canada

By Claire Barber, MD, PhD, FRCPC

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Variability in clinical data collection has been identified as a barrier to quality measurement, since it creates challenges in terms of maintenance of complete patient records and monitoring the provision of care. The Arthritis Alliance of Canada (AAC) partnered with the Canadian Rheumatology Association (CRA) and individual investigators to develop a Canadian Rheumatoid Arthritis Core Clinical Dataset (CAN-RACCD) to encourage best practices and to facilitate future quality measurement efforts.

The CAN-RACCD was developed through a three-phase program that included an environmental scan to identify a candidate set of core data elements, stakeholder meetings to prioritize elements for inclusion, and a modified-Delphi process to finalize the core clinical dataset. Broad input was gained from 47 rheumatologists, people living with arthritis, and allied health providers from across Canada.

The CAN-RACCD includes 49 individual data elements across nine categories: (1) demographic; (2) timing - including dates of symptom onset, referral, first visit and diagnosis; (3) clinical data; (4) disease activity; (5) comorbidities; (6) smoking status; (7) patient-reported outcomes; (8) medications; and (9) laboratory and radiographic data

This is an important first step in standardizing measurement that will help improve the quality of care of people living with rheumatoid arthritis.

Dr. Claire Barber, Assistant Professor, Rheumatologist, University of
Calgary, Calgary, AB

Reference:

Barber CEH, et al. Development of a Canadian core clinical dataset to support high quality care for rheumatoid arthritis patients in Canada. J Rheumatol 2017 Dec; 44(12):1813-22.


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