Widdifield Jessica, Ivers Noah M, Bernatsky Sasha, Jaakkimainen Liisa, Bombardier Claire, Thorne J Carter, Ahluwalia Vandana, Paterson J Michael, Young Jacqueline, Wing Laura, Tu Karen
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada.
Institute for Clinical Evaluative Sciences, University of Toronto, and Women's College Hospital, Toronto, Ontario, Canada.
Arthritis Care Res (Hoboken). 2017 Oct;69(10):1495-1503. doi: 10.1002/acr.23178. Epub 2017 Aug 22.
Quality measurement for rheumatoid arthritis (RA) patients has largely focused on care provided by rheumatologists. Our aim was to develop and assess quality measures related to the screening and management of comorbidity in RA patients in primary care.
We used the primary care Electronic Medical Record Administrative data Linked Database in Ontario, Canada. We harmonized Canadian general population and RA clinical recommendations to develop and assess screening, process, and outcome measures. For each RA patient, 10 non-RA patients were matched by age and sex. Stratified analyses were performed, comparing patients with RA to those without RA, to assess the performance of quality measures.
We compared 1,405 RA patients to 14,050 matched non-RA patients (72.8% female; mean age 62.5 years). Compared to non-RA patients, RA patients more frequently had influenza (44.9% versus 40.0%) and pneumococcal (40.4% versus 34.1%) vaccinations and bone mineral density testing (67.4% versus 58.1%). Herpes zoster vaccinations were less frequent among RA patients (13.8% versus 19.5%), as was screening for cervical cancer (58.6% versus 64.0%). No significant differences were observed between RA and non-RA patients in screenings for breast (70.7% versus 73.8%) or colorectal (31.7% versus 34.5%) cancers. Only a quarter of RA patients had a comprehensive cardiovascular risk assessment. No definitive differences were detected in the management of patients who had co-occurring cardiovascular disease or diabetes mellitus.
For both RA and non-RA patients, compliance with Canadian recommendations for preventive medical services and screening for comorbid conditions in primary care was less than optimal. This indicates key targets for improvement.
类风湿关节炎（RA）患者的质量测量主要集中在风湿病学家提供的护理上。我们的目的是制定和评估与初级保健中RA患者合并症筛查和管理相关的质量指标。
我们使用了加拿大安大略省的初级保健电子病历管理数据链接数据库。我们协调了加拿大普通人群和RA临床建议，以制定和评估筛查、过程和结果指标。对于每例RA患者，按年龄和性别匹配10例非RA患者。进行分层分析，比较RA患者和非RA患者，以评估质量指标的性能。
我们将1405例RA患者与14050例匹配的非RA患者进行了比较（女性占72.8%；平均年龄62.5岁）。与非RA患者相比，RA患者更频繁地接受流感（44.9%对40.0%）和肺炎球菌（40.4%对34.1%）疫苗接种以及骨密度检测（67.4%对58.1%）。RA患者中带状疱疹疫苗接种频率较低（13.8%对19.5%），宫颈癌筛查频率也较低（58.6%对64.0%）。RA患者和非RA患者在乳腺癌（70.7%对73.8%）或结直肠癌（31.7%对34.5%）筛查方面未观察到显著差异。只有四分之一的RA患者进行了全面的心血管风险评估。在合并心血管疾病或糖尿病患者的管理方面未发现明确差异。
对于RA患者和非RA患者，在初级保健中对预防性医疗服务的遵循情况以及合并症筛查情况均未达到最佳。这表明了需要改进的关键目标。
