Anderson Erik, Bajaj Puneet, Raghavan Siddharth, Patnaik Asha, Roppelt Heidi
From the *North Shore-LIJ Health System, NY; †University of Texas Southwestern Medical Center, Dallas, TX; and ‡Stony Brook University Medical Center, Stony Brook, NY.
J Clin Rheumatol. 2016 Mar;22(2):63-7. doi: 10.1097/RHU.0000000000000323.
The American College of Rheumatology endorses 7 rheumatoid arthritis (RA) quality indicators (QIs), which we used to access quality of care at our institution.
The aim of this study was to assess the quality of care provided to RA patients at our outpatient rheumatology practice based on adherence to 7 QIs.
We performed a retrospective paper chart review and included 356 RA patients to determine adherence to each QI. A χ test analyzed trends in the assessment of disease activity and functional status.
There was excellent adherence to disease-modifying antirheumatic drug therapy (99.4%) and managing worsening disease (100%). Assessment of disease activity and functional status increased over the study period (72.8% to 94.2% and 70.8% to 93.4%, respectively). Despite this, none of our patients had disease prognosis classified and documented. Tuberculosis screening was done in 87.9%. Only a small percentage (1.4%) of patients met criteria for a glucocorticoid management plan, thus limiting our assessment of this QI.
Excellent adherence to disease-modifying antirheumatic drug therapy and management is likely due to targeting clinical remission. Assessment of disease activity and functional status not only rose each year, but also is higher compared with similar studies. This may be due to an increased awareness of QIs and the utility of objective measures of disease activity. Deficient documentation of prognosis may be due to a lack of awareness of its importance. Suboptimal tuberculosis screening may be an artifact of poor documentation. We propose interventions to improve adherence.
美国风湿病学会认可7项类风湿性关节炎（RA）质量指标（QIs），我们用这些指标来评估我们机构的医疗质量。
本研究的目的是基于对7项质量指标的遵循情况，评估我们门诊风湿病科为RA患者提供的医疗质量。
我们进行了一项回顾性纸质病历审查，纳入356例RA患者以确定对每项质量指标的遵循情况。采用χ检验分析疾病活动度和功能状态评估的趋势。
对改善病情抗风湿药物治疗（99.4%）和控制病情恶化（100%）的遵循情况极佳。在研究期间，疾病活动度和功能状态的评估有所增加（分别从72.8%增至94.2%和从70.8%增至93.4%）。尽管如此，我们的患者中没有一人对疾病预后进行分类和记录。87.9%的患者进行了结核病筛查。只有一小部分（1.4%）患者符合糖皮质激素管理计划的标准，因此限制了我们对该质量指标的评估。
对改善病情抗风湿药物治疗和管理的极佳遵循情况可能归因于以临床缓解为目标。疾病活动度和功能状态的评估不仅逐年上升，而且与类似研究相比更高。这可能是由于对质量指标的认识增加以及疾病活动度客观测量方法的实用性。预后记录不足可能是由于对其重要性缺乏认识。结核病筛查不理想可能是记录不佳造成的假象。我们提出了改善遵循情况的干预措施。
