For the first time, nationally endorsed performance measures in British Columbia, Canada, were operationalized using administrative data, allowing for population-level quality of care reports on patients with rheumatoid arthritis (RA). The reports showed improvements in access to rheumatologist care and early treatment over time, although suboptimal rates of specialist follow-up and accompanying low levels of disease modifying antirheumatic drug (DMARD) use persisted, according to study findings published in Arthritis Care & Research.
This longitudinal population-based RA cohort study used administrative health data to operationalize and report on 4 of 6 nationally endorsed RA performance measures developed by the Arthritis Alliance of Canada. The 4 tested performance measures were: percentage of incident patients with ≥1 rheumatologist visits within 365 days of diagnosis; proportion of prevalent RA patients with ≥1 rheumatologist visits per year; percentage of prevalent RA patients who received DMARD therapy; and time from RA diagnosis to DMARD prescription. All adult patients who received care for RA in British Columbia from January 1, 1997, to December 31, 2009, were identified and followed until December 2014.
A total of 38,673 incident cases and 57,922 prevalent cases of RA were included in the cohort. Although the percentage of patients seeing a rheumatologist in the first year of diagnosis was suboptimal, rates improved from 35% in 2000 to 65% in 2009. Improved performance was noticed in patients who ever saw a rheumatologist in follow-up, which increased from 74% in 2000 to 96% in 2009; however, the lower performance in earlier years could have been due to longer follow-up times. When the measure was reported as patients seeing a rheumatologist within the first 5 years, the performance became 88% in 2000 and 97% in 2009.
The percentage of patients with RA under the care of a rheumatologist declined from 79% in 2001 to 39% in 2014 using the fixed interval method, or from 82% in 2001 to 42% in 2014 using the gaps method. Among patients not under the care of a rheumatologist, DMARD use was suboptimal, with little improvement over time. Overall, regardless of physician type, only 37% of patents were prescribed a DMARD in 2014, with the highest rates of DMARD use (87% in 2014) seen among patients under active rheumatology care. The median time from RA diagnosis to DMARD therapy initiation in patients seen by a rheumatologist improved from 49 days in 2000 to 23 days in 2009, with 21% and 34% receiving DMARD treatment within the 14-day benchmark in 2000 and 2009, respectively.
The investigators concluded that “the results of this study will inform further reporting on the measures nationally and help serve in benchmarking when planning quality improvement and advocacy work.”
“Timely communication of performance at the practice level could be used to influence clinical care,” they added.
Barber CEH, Marshall DA, Szefer E, et al. A population-based approach to reporting system-level performance measures for rheumatoid arthritis care [published online March 7, 2020]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24178