Division of Rheumatology, McGill University, Montréal, Quebec, Canada.
J Clin Rheumatol. 2013 Jun;19(4):175-9. doi: 10.1097/RHU.0b013e3182937094.
In rheumatoid arthritis (RA), quality indicators (QIs) are tools used to measure process of care. This study aimed to assess performance of selected QIs from the 2004 Arthritis Foundation's QI Set at 2 major sites of a university network of teaching hospitals.
The charts and electronic hospital records of 76 RA patients were audited to determine adherence to QIs. Logistic multivariate regression analyses were performed to investigate potential determinants of nonadherence and propose measures to facilitate better QI compliance, as a potential strategy towards RA care improvement.
We identified consistent observance of QIs mandating prescription of disease-modifying antirheumatic drug therapy for all patients, drug adjustment with disease activity, prednisone tapering, and bisphosphonate therapy if indicated for patients on glucocorticoids. However, there was either lack of documentation or true inconsistent adherence to QIs dealing with radiograph performance, functional capacity assessment, and screening for hepatitis and tuberculosis before commencement of methotrexate and biologic agents, respectively. For the specific QIs analyzed, we did not find any definite independent associations with the studied variables.
Our findings indicate that while there is frequent evidence for adherence to certain RA quality care standards at our centers, there is less compliance to others. Strategies to optimize the performance or documentation of those found most lacking, namely, functional capacity and screening for specific drug contraindications, could improve patient care. Radiographic disease monitoring, while lacking, may represent a move toward other more sensitive methods of RA progression detection, such as joint ultrasound. The inclusion of patient- and physician-derived information could help elucidate the reasons underlying nonadherence.
在类风湿关节炎（RA）中，质量指标（QI）是用于衡量治疗过程的工具。本研究旨在评估大学网络教学医院的 2 个主要站点使用 2004 年关节炎基金会 QI 集的选定 QI 的表现。
对 76 例 RA 患者的图表和电子病历进行审核，以确定对 QI 的遵守情况。进行逻辑多元回归分析，以调查非依从性的潜在决定因素，并提出促进更好的 QI 依从性的措施，作为改善 RA 护理的潜在策略。
我们发现，对于所有患者，都一致遵守了规定使用疾病修饰抗风湿药物治疗的 QI，根据疾病活动度调整药物、泼尼松减量，以及对于正在使用糖皮质激素的患者使用双膦酸盐治疗。然而，在开始使用甲氨蝶呤和生物制剂之前，分别在影像学表现、功能能力评估以及筛查乙型肝炎和结核病方面，存在缺乏文件记录或真正不遵守 QI 的情况。对于分析的特定 QI，我们没有发现任何与研究变量有明确独立关联的情况。
我们的研究结果表明，虽然我们中心经常有证据表明对某些 RA 质量护理标准的遵守，但对其他标准的遵守程度较低。优化那些发现最缺乏的 QI 的性能或记录的策略，即功能能力和特定药物禁忌的筛查，可能会改善患者的护理。影像学疾病监测虽然缺乏，但可能代表着向其他更敏感的 RA 进展检测方法的转变，如关节超声。包括患者和医生提供的信息可以帮助阐明不依从的原因。
