Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor.
School of Medicine, Chang Gung University, Taoyuan, Taiwan.
JAMA Netw Open. 2022 Dec 1;5(12):e2246299. doi: 10.1001/jamanetworkopen.2022.46299.
Although quality care markers exist for patients with rheumatoid arthritis (RA), the predictors of meeting these markers are unclear.
To explore factors associated with quality care among patients with RA.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study using insurance claims from 2009 to 2017 was conducted, and 6 sequential logistic regression models were built to evaluate quality care markers. Quality care markers were measured at 1 year post-RA diagnosis for each patient. The MarketScan Research Database, which contains commercial and Medicare Advantage administrative claims data from more than 100 million individuals in the US, was used to identify patients aged 18 to 64 years with a diagnosis claim for RA. Patients with conditions presenting similar to RA and missing demographic characteristics were excluded. Data analysis occurred between February 18 and May 5, 2022.
Success or failure to meet selected RA quality care markers within 1 year after RA diagnosis.
Prevalence of meeting successive quality care markers for RA.
Among 581 770 patients, 430 843 (74.1%) were women and the mean (SD) age was 48.9 (11.3) years. Most patients (236 285 [40.6%]) resided in the South and had an income less than or equal to $45 200 (490 366 [84.3%]). Of the total study population, 399 862 individuals (68.7%) met at least 1 quality care marker and 181 908 (31.3%) met 0 markers. Most commonly, patients met annual laboratory testing (299 323 [51.5%]) and referral to a rheumatologist (256 765 [44.1%]) markers. The least met marker was receiving hepatitis B screening prior to initiation of disease-modifying antirheumatic drug (DMARD) therapy (18 548 [3.2%]). Women were most likely to meet all quality care markers except receiving DMARDs with hepatitis B screening (odds ratio, 1.14; 95% CI, 1.12-1.16). Individuals with lower median household income had lower odds of receiving a rheumatologist referral, an annual physical examination, or annual laboratory testing, but greater odds of receiving the other quality care markers. Patients with Medicare and those with comorbidities were generally less likely to meet quality care markers.
In this cohort study of patients with RA, findings indicated downstream associations with rheumatologist referral and receiving DMARDs and varied associations between meeting quality care markers and patient characteristics. These findings suggest that prioritizing early care, especially for vulnerable patients, will ensure that quality care continues.
尽管存在针对类风湿关节炎 (RA) 患者的质量护理指标，但这些指标的预测因素尚不清楚。
探讨与 RA 患者的优质护理相关的因素。
设计、设置和参与者：使用 2009 年至 2017 年的保险索赔进行回顾性队列研究，并建立了 6 个连续的逻辑回归模型来评估质量护理指标。为每位患者在 RA 诊断后 1 年内测量了质量护理指标。MarketScan Research Database 包含了来自美国 1 亿多人的商业和 Medicare Advantage 管理索赔数据，用于识别年龄在 18 至 64 岁之间的 RA 诊断索赔患者。排除了表现出与 RA 相似的病症且缺少人口统计学特征的患者。数据分析于 2022 年 2 月 18 日至 5 月 5 日之间进行。
在 RA 诊断后 1 年内成功或未能达到选定的 RA 质量护理指标。
符合 RA 连续质量护理指标的流行率。
在 581770 名患者中，430843 名（74.1%）为女性，平均（SD）年龄为 48.9（11.3）岁。大多数患者（236285 名 [40.6%]）居住在南部，收入低于或等于 45200 美元（490366 名 [84.3%]）。在总研究人群中，399862 人（68.7%）至少符合 1 项质量护理指标，181908 人（31.3%）不符合任何指标。最常见的是符合年度实验室检测（299323 名 [51.5%]）和转诊给风湿病专家（256765 名 [44.1%]）的指标。最不符合的指标是在开始使用疾病修饰抗风湿药物（DMARD）治疗之前进行乙型肝炎筛查（18548 名 [3.2%]）。女性最有可能符合所有质量护理指标，但不符合接受乙型肝炎筛查的 DMARD 治疗（优势比，1.14；95%CI，1.12-1.16）。收入中位数较低的个体接受风湿病专家转诊、年度体检或年度实验室检测的可能性较低，但接受其他质量护理指标的可能性较高。有医疗保险和合并症的患者通常不太可能符合质量护理指标。
在这项针对 RA 患者的队列研究中，研究结果表明与风湿病专家转诊和接受 DMARD 治疗呈下游关联，并且与符合质量护理指标和患者特征之间存在多种关联。这些发现表明，优先考虑早期护理，特别是对弱势患者，将确保持续提供优质护理。
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