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Evaluating quality of care for rheumatoid arthritis for the population of Alberta using system-level performance measures.

Journal of Rheumatology 2020 September 16
OBJECTIVE: We evaluated 4 national rheumatoid arthritis (RA) system-level performance measures (PMs) 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: proportion of incident RA cases with a rheumatologist visit within one year of first RA diagnosis code (PM1); proportion of prevalent RA patients dispensed a disease modifying anti-rheumatic 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 31566 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 DMARDs annually (PM2) remained low at 43%. While the median time to DMARD from first visit date in people who received DMARDs improved over time from 39 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 health care system for RA is suboptimal, indicating barriers to accessing specialty care and treatment. The results inform quality improvement initiatives required within the province to meet national standards of care.

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