五种照护模式下类风湿关节炎系统性能测量及依从性的可行性。
Feasibility of Measurement and Adherence to System Performance Measures for Rheumatoid Arthritis in 5 Models of Care.
机构信息
From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.
C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada.
出版信息
J Rheumatol. 2018 Nov;45(11):1501-1508. doi: 10.3899/jrheum.171284. Epub 2018 Jun 15.
OBJECTIVE
To test the feasibility of reporting on 4 national performance measures for patients with rheumatoid arthritis (RA) in 5 different models of care.
METHODS
The following performance measures were evaluated in 5 models of care: waiting time (WT) to rheumatologist consultation, percentage of patients seen in yearly followup (FU), percentage taking disease-modifying antirheumatic drugs (DMARD), and time to starting DMARD. All models aimed to improve early access and care for patients with RA.
RESULTS
A number of feasibility issues were encountered in performance measure evaluation because of differences in site data collection and/or the duration of the model of care. For example, while 4/5 programs maintained clinical or research databases, chart reviews were still required to report on WT. Median WT for care in 2015 varied by site between 21 and 75 days. Yearly FU rates could only be calculated in 2 sites (combined owing to small numbers) and varied between 83% and 100%. Percentage of patients taking a DMARD and time to DMARD could be calculated in 3 models, and rates of DMARD use were between 90% and 100%, with median time to DMARD of 0 days in each.
CONCLUSION
Our review has shown that even in models of care designed to improve access to care and early treatment, data to document improvements are often lacking. Where data were available for measuring, deficits in WT performance were noted for some centers. Our results highlight a need to improve reporting processes to drive quality improvement.
目的
测试在 5 种不同的护理模式下报告 4 项针对类风湿关节炎（RA）患者的国家绩效指标的可行性。
方法
在 5 种护理模式下评估了以下绩效指标：风湿科医生咨询的等待时间（WT）、每年随访（FU）中接受治疗的患者比例、服用疾病修正抗风湿药物（DMARD）的患者比例以及开始 DMARD 治疗的时间。所有模型均旨在改善 RA 患者的早期就诊和护理。
结果
在绩效评估中遇到了一些可行性问题，这是由于各站点的数据收集和/或护理模式的持续时间存在差异所致。例如，虽然 4/5 个项目都维护着临床或研究数据库，但仍需要进行图表审查以报告 WT。2015 年，各站点的 WT 中位数因站点而异，范围在 21 至 75 天之间。由于数量较少，只有 2 个站点可以计算每年 FU 率，其范围在 83%至 100%之间。在 3 个模型中可以计算出服用 DMARD 的患者比例和开始 DMARD 治疗的时间，DMARD 使用率在 90%至 100%之间，每个模型的 DMARD 中位时间为 0 天。
结论
我们的审查表明，即使在旨在改善就诊和早期治疗的护理模式中，用于证明改进的相关数据也常常缺乏。在有数据可用于衡量的情况下，一些中心的 WT 绩效仍存在缺陷。我们的结果强调需要改进报告流程，以推动质量改进。
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