Evaluating Quality of Care for Rheumatoid Arthritis for the Population of Alberta Using System-level Performance Measures

Claire E H Barber; Diane Lacaille; Peter Faris; Dianne Mosher; Steven Katz; Jatin N Patel; Sharon Zhang; Karen Yee; Cheryl Barnabe; Glen S Hazlewood; Vivian Bykerk; Natalie J Shiff; Marinka Twilt; Jennifer Burt; Susanne M Benseler; Joanne Homik; Deborah A Marshall

doi:10.3899/jrheum.200420

Evaluating Quality of Care for Rheumatoid Arthritis for the Population of Alberta Using System-level Performance Measures

J Rheumatol. 2021 Apr;48(4):482-485. doi: 10.3899/jrheum.200420. Epub 2020 Sep 15.

Authors

Claire E H Barber¹, Diane Lacaille², Peter Faris³, Dianne Mosher⁴, Steven Katz⁵, Jatin N Patel⁶, Sharon Zhang³, Karen Yee³, Cheryl Barnabe⁷, Glen S Hazlewood⁷, Vivian Bykerk⁸, Natalie J Shiff⁹, Marinka Twilt¹⁰, Jennifer Burt¹¹, Susanne M Benseler¹⁰, Joanne Homik⁵, Deborah A Marshall⁷

Affiliations

¹ C.E. Barber, MD, FRCPC, PhD, Assistant Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, D.A. Marshall, PhD, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and Department of Community Health Sciences, University of Calgary, and Arthritis Research Canada, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada; cehbarbe@ucalgary.ca.
² D. Lacaille, MD, FRCPC, MHSc, Professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and Scientific Director, Arthritis Research Canada.
³ P. Faris, PhD, Director, Health Services Statistical and Analytic Methods Analytics (DIMER), S. Zhang, MSc, Senior Data Analyst, K. Yee, MSc, MPH, Senior Data Analyst, Alberta Health Services, Calgary, Alberta, Canada.
⁴ D. Mosher, MD, FRCPC, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada.
⁵ S. Katz, MD, FRCPC, J. Homik, MD, FRCPC, MSc, Professor, Department of Medicine, University of Alberta, Calgary, Alberta, Canada.
⁶ J.N. Patel, MBT, Project Manager, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁷ C.E. Barber, MD, FRCPC, PhD, Assistant Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, D.A. Marshall, PhD, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and Department of Community Health Sciences, University of Calgary, and Arthritis Research Canada, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada.
⁸ V. Bykerk, MD, FRCPC, Associate Professor, Hospital for Special Services, New York, New York, USA.
⁹ N. J. Shiff, MD, MHSc, Adjunct Professor, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁰ M. Twilt, MD, MSCE, PhD, Assistant Professor, S.M. Benseler, MD, PhD, Professor, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹¹ J. Burt, PT, ACPAC-trained ERP, St Clare's Mercy Hospital, St. John's, Newfoundland, Canada.

PMID: 32934120
DOI: 10.3899/jrheum.200420

Abstract

Objective: We evaluated 4 national rheumatoid arthritis (RA) system-level performance measures (PM) in Alberta, Canada.

Methods: Incident and prevalent RA cases ≥ 16 years of age since 2002 were identified using a validated case definition applied in provincial administrative data. Performance was ascertained through analysis of health data between fiscal years 2012/13-2015/16. Measures evaluated were as follows: proportion of incident RA cases with a rheumatologist visit within 1 year of first RA diagnosis code (PM1); proportion of prevalent RA patients who were dispensed a disease-modifying antirheumatic drug (DMARD) annually (PM2); time from first visit with an RA code to DMARD dispensation and proportion of incident cases where the 14-day benchmark for dispensation was met (PM3); and proportion of patients seen in annual follow-up (PM4).

Results: There were 31,566 prevalent and 2730 incident RA cases (2012/13). Over the analysis period, the proportion of patients seen by a rheumatologist within 1 year of onset (PM1) increased from 55% to 63%; however, the proportion of RA patients dispensed DMARD annually (PM2) remained low at 43%. While the median time to DMARD from first visit date in people who received DMARD improved over time from 39 days to 28 days, only 38-41% of patients received treatment within the 14-day benchmark (PM3). The percentage of patients seen in yearly follow-up (PM4) varied between 73-80%.

Conclusion: The existing Alberta healthcare system for RA is suboptimal, indicating barriers to accessing specialty care and treatment. Our results inform quality improvement initiatives required within the province to meet national standards of care.

Keywords: access; quality improvement; quality indicator.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Alberta / epidemiology
Antirheumatic Agents* / therapeutic use
Arthritis, Rheumatoid* / diagnosis
Arthritis, Rheumatoid* / drug therapy
Arthritis, Rheumatoid* / epidemiology
Humans
Quality of Health Care
Rheumatologists

Substances

Antirheumatic Agents