1
|
Bingham CA, Harris JG, Qiu T, Gilbert M, Vora SS, Yildirim-Toruner C, Ferraro K, Lovell DJ, Taylor J, Mannion ML, Weiss JE, Laxer RM, Shishov M, Oberle EJ, Gottlieb BS, Lee TC, Pan N, Burnham JM, Fair DC, Batthish M, Hazen MM, Spencer CH, Morgan EM. Pediatric Rheumatology Care and Outcomes Improvement Network's Quality Measure Set to Improve Care of Children With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2023; 75:2442-2452. [PMID: 37308458 DOI: 10.1002/acr.25168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the selection, development, and implementation of quality measures (QMs) for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a multihospital learning health network using quality improvement methods and leveraging QMs to drive improved outcomes across a JIA population since 2011. METHODS An American College of Rheumatology-endorsed multistakeholder process previously selected initial process QMs. Clinicians in PR-COIN and parents of children with JIA collaboratively selected outcome QMs. A committee of rheumatologists and data analysts developed operational definitions. QMs were programmed and validated using patient data. Measures are populated by registry data, and performance is displayed on automated statistical process control charts. PR-COIN centers use rapid-cycle quality improvement approaches to improve performance metrics. The QMs are revised for usefulness, to reflect best practices, and to support network initiatives. RESULTS The initial QM set included 13 process measures concerning standardized measurement of disease activity, collection of patient-reported outcome assessments, and clinical performance measures. Initial outcome measures were clinical inactive disease, low pain score, and optimal physical functioning. The revised QM set has 20 measures and includes additional measures of disease activity, data quality, and a balancing measure. CONCLUSION PR-COIN has developed and tested JIA QMs to assess clinical performance and patient outcomes. The implementation of robust QMs is important to improve quality of care. PR-COIN's set of JIA QMs is the first comprehensive set of QMs used at the point-of-care for a large cohort of JIA patients in a variety of pediatric rheumatology practice settings.
Collapse
Affiliation(s)
- Catherine A Bingham
- Penn State Children's Hospital and Penn State College of Medicine, Hershey, Pennsylvania
| | - Julia G Harris
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Tingting Qiu
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Sheetal S Vora
- Levine Children's Hospital and Atrium Health, Charlotte, North Carolina
| | | | - Kerry Ferraro
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Janalee Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Jennifer E Weiss
- Hackensack University Medical Center and Hackensack Meridian Health, Hackensack, New Jersey
| | - Ronald M Laxer
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | - Edward J Oberle
- Nationwide Children's Hospital and The Ohio State University, Columbus
| | - Beth S Gottlieb
- Cohen Children's Medical Center of New York and Zucker School of Medicine at Hofstra/Northwell, Queens, New York
| | - Tzielan C Lee
- Stanford Medicine Children's Health, Stanford University, Stanford, California
| | - Nancy Pan
- Hospital for Special Surgery and Cornell University, New York, New York
| | - Jon M Burnham
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Danielle C Fair
- Medical College of Wisconsin and Children's Wisconsin, Milwaukee
| | - Michelle Batthish
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | | | | | - Esi M Morgan
- Seattle Children's Hospital and the University of Washington, Seattle
| |
Collapse
|
2
|
Ngan Kee R, Milne V, Dalbeth N, Grainger R. Patient participation in defining best-practice rheumatology service provision in Aotearoa New Zealand: a qualitative study with service consumers. BMC Rheumatol 2023; 7:1. [PMID: 36694263 PMCID: PMC9872402 DOI: 10.1186/s41927-022-00319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/02/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Aotearoa New Zealand (AoNZ) has no agreed models for rheumatology service provision in government-funded health care. We aimed to describe what people with inflammatory rheumatic diseases who have used rheumatology services view as being important in those services, and map these views to previously collated statements describing best practice components of rheumatology services from international recommendations. If these statements did not capture all service aspects that people with inflammatory rheumatic diseases considered important, we aimed to co-create new statements with our patient-participants. METHODS We conducted one focus group and an interview with people with inflammatory rheumatic disease who had used a government-funded rheumatology service in the previous 5 years (patient-participants) and analysed data using thematic analysis. The research team mapped subthemes to previously collated best practice recommendations that had been included in a Delphi consensus exercise with rheumatologists in AoNZ and proposed new statements, based on patient-participant data. Patient-participant feedback on thematic analysis and the new statements led to a refining of statements. A patient-partner in the research team informed research design and data analysis. RESULTS Patient-participants viewed it as highly valuable for rheumatology services to respect and value their experiences as people and patients, and those of their whānau (Māori word for family). They expected rheumatology services to provide the right care, at the right time. Many of the subthemes mapped to the best-practice statements. However, three new principles and three new statements were developed and refined by patient-participants. The three principles addressed valuing individuals, and their whānau (family) and their experiences, and providing a patient-focused health system that supports patient participation in decision-making and self-management, and patient education. New statements related to having a specific rheumatologist and other staff for comprehensive care, having adequate nurse staffing, and active provision of outside services and support. CONCLUSION It was important to patients that rheumatology services demonstrated that patients and their whānau (family) were valued. The inclusion of people with rheumatic diseases who are users of rheumatology services in service development can provide valuable insights to inform how services should be delivered.
Collapse
Affiliation(s)
- Rachel Ngan Kee
- grid.29980.3a0000 0004 1936 7830Department of Medicine, University of Otago Wellington, 23a Mein St, PO Box 7343, Newtown, Wellington South 6242 New Zealand
| | | | - Nicola Dalbeth
- grid.9654.e0000 0004 0372 3343Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand ,grid.414057.30000 0001 0042 379XDepartment of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Rebecca Grainger
- grid.29980.3a0000 0004 1936 7830Department of Medicine, University of Otago Wellington, 23a Mein St, PO Box 7343, Newtown, Wellington South 6242 New Zealand ,grid.413663.50000 0001 0842 2548Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
| |
Collapse
|
3
|
Bailey K, Lee S, de Los Reyes T, Lo L, Cleverley K, Pidduck J, Mahood Q, Gorter JW, Toulany A. Quality Indicators for Youth Transitioning to Adult Care: A Systematic Review. Pediatrics 2022; 150:188245. [PMID: 35665828 DOI: 10.1542/peds.2021-055033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transition from pediatric to adult care is associated with adverse health outcomes for many adolescents with chronic illness. We identified quality indicators for transition to adult care that are broadly applicable across chronic illnesses and health systems. METHODS Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature were searched, covering earliest available date to July 2021. The Gray Matters framework was used to search gray literature. Two independent reviewers screened articles by title and abstract, followed by full-text review. Disagreements were resolved by a third reviewer. Studies were included that identified quality indicators developed via consensus-building methods. Indicators were organized into a framework categorized by illness specificity, level of care, Donabedian model, and Institute of Medicine quality domain. Appraisal of Guidelines for Research and Evaluation tool was used for critical appraisal. RESULTS The search identified 4581 articles, of which 321 underwent full-text review. Eight peer-reviewed studies and 1 clinical guideline were included, identifying 169 quality indicators for transition. Of these, 56% were illness specific, 43% were at the patient level of care, 44% related to transition processes, and 51% were patient centered and 0% equity focused. Common indicator themes included education (12%), continuity of care (8%), satisfaction (8%), and self-management/self-efficacy (7%). The study was limited by quality indicators developed through consensus-building methodology. CONCLUSIONS Although most quality indicators for transition were patient-centered outcomes, few were informed by youth and parents/caregivers, and none focused on equity. Further work is needed to prioritize quality indicators across chronic illness populations while engaging youth and parents/caregivers in the process.
Collapse
Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine.,Institute of Health Policy, Management and Evaluation
| | - Stephanie Lee
- Department of Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Adolescent Medicine, Monash Children's Hospital, Melbourne, Australia
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Kristin Cleverley
- Temerty Faculty of Medicine.,Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | - Jan Willem Gorter
- Department of Rehabilitation, Physical Therapy Science & Sports.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Alene Toulany
- Temerty Faculty of Medicine.,Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Sand-Svartrud AL, Berdal G, Azimi M, Bø I, Dager TN, Eppeland SG, Fredheim GO, Hagland AS, Klokkeide Å, Linge AD, Sexton J, Tennebø K, Valaas HL, Mjøsund K, Dagfinrud H, Kjeken I. Associations between quality of health care and clinical outcomes in patients with rheumatic and musculoskeletal diseases: a rehabilitation cohort study. BMC Musculoskelet Disord 2022; 23:357. [PMID: 35428256 PMCID: PMC9011960 DOI: 10.1186/s12891-022-05271-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The quality of provided health care may be an important source of variation in rehabilitation outcomes, increasing the interest in associations between quality indicators (QIs) and improved patient outcomes. Therefore, we examined the associations between the quality of rehabilitation processes and subsequent clinical outcomes among patients with rheumatic and musculoskeletal diseases (RMDs). METHODS In this multicentre prospective cohort study, adults with RMDs undergoing multidisciplinary rehabilitation at eight participating centres reported the quality of rehabilitation after 2 months and outcomes after 2, 7, and 12 months. We measured perceived quality of rehabilitation by 11 process indicators that cover the domains of initial assessments, patient participation and individual goal-setting, and individual follow-up and coordination across levels of health care. The patients responded "yes" or "no" to each indicator. Scores were calculated as pass rates (PRs) from 0 to 100% (best score). Clinical outcomes were goal attainment (Patient-Specific Functional Scale), physical function (30 s sit-to-stand test), and health-related quality of life (EuroQoL 5D-5L). Associations between patient-reported quality of care and each outcome measure at 7 months was analysed by linear mixed models. RESULTS A total of 293 patients were enrolled in this study (mean age 52 years, 76% female). Primary diagnoses were inflammatory rheumatic disease (64%), fibromyalgia syndrome (18%), unspecific neck, shoulder, or low back pain (8%), connective tissue disease (6%), and osteoarthritis (4%). The overall median PR for the process indicators was 73% (range 11-100%). The PR was lowest (median 40%) for individual follow-up and coordination across levels of care. The mixed model analyses showed that higher PRs for the process indicators were not associated with improved goal attainment or improved physical function or improved health-related quality of life. CONCLUSIONS The quality of rehabilitation processes was not associated with important clinical outcomes. An implication of this is that measuring only the outcome dimension of quality may result in incomplete evaluation and monitoring of the quality of care, and we suggest using information from both the structure, process, and outcome dimensions to draw inferences about the quality, and plan future quality initiatives in the field of complex rehabilitation. TRIAL REGISTRATION The study is part of the larger BRIDGE trial (ClinicalTrials.gov NCT03102814 ).
Collapse
Affiliation(s)
- Anne-Lene Sand-Svartrud
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway.
| | - Gunnhild Berdal
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Maryam Azimi
- Patient Advisory Board, Division of Rheumatology and Research Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Bø
- Hospital for Rheumatic Diseases Lillehammer, Margrethe Grundtvigs veg 6, N-2609, Lillehammer, Norway
| | - Turid Nygaard Dager
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Siv Grødal Eppeland
- Sørlandet Hospital Arendal, PO Box 416, Lundsiden, N-4604, Kristiansand, Norway
| | | | - Anne Sirnes Hagland
- Hospital for Rheumatic Diseases Haugesund, PO Box 2175, N-5504, Haugesund, Norway
| | - Åse Klokkeide
- Rehabilitering Vest Rehabilitation Centre, PO Box 2175,, N-5504, Haugesund, Norway
| | - Anita Dyb Linge
- Muritunet Rehabilitation Centre, Grandedata 58, N-6210, Valldal, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kjetil Tennebø
- Valnesfjord Health Sports Centre, Østerkløftveien 249, N-8215, Valnesfjord, Norway
| | | | - Kristin Mjøsund
- Meråker Rehabilitation Centre, Østigardsveien 24, N-7530, Meråker, Norway
| | - Hanne Dagfinrud
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| |
Collapse
|
5
|
Bailey K, Lee S, de Los Reyes T, Lo L, Gorter JW, Toulany A. Quality indicators for transition from paediatric to adult care for adolescents with chronic physical and mental illness: protocol for a systematic review. BMJ Open 2021; 11:e055194. [PMID: 34725083 PMCID: PMC8562538 DOI: 10.1136/bmjopen-2021-055194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Transition from paediatric to adult care is a complex process, which poses significant challenges for adolescents with chronic physical and mental illnesses. For many, transfer to adult care is associated with poor health and psychosocial outcomes. Quality indicators to evaluate transition to adult care are needed to benchmark and compare performance across conditions and health systems. This systematic review aims to identify quality indicators for successful transition to adult care which can be applied across chronic physical and/or mental illnesses. METHODS Published literature will be searched using MEDLINE, Embase and CINHAL from earliest available date to July 2021. Grey literature will be searched using the Grey Matters tool. Using a set of inclusion/exclusion criteria, two independent reviewers will screen titles and abstracts, followed by full-text review. Disagreements will be resolved by a third reviewer. Study selection and data extraction will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Study appraisal will be completed using the Appraisal of Guidelines for Research and Evaluation for Quality Indicators instrument. Extracted quality indicators will be categorised into a conceptual framework. ETHICS AND DISSEMINATION Results from this review will offer novel insights into quality indicators that may be used to measure and evaluate transition success across conditions, which will be disseminated via a Canadian transition collaborative, workshops and peer-reviewed publication. Extracted quality indicators will be further prioritised in a Delphi study with patients, caregivers and providers. This is a critical step in developing a core set of metrics to evaluate transitions to adult care. Ethics approval is not required as this review will identify and synthesise findings from published literature. PROSPERO REGISTRATION NUMBER CRD42020198030.
Collapse
Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Lee
- Department of Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Adolescent Medicine, Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Thomas de Los Reyes
- Department of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisha Lo
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Barber C, Lacaille D, Hall M, Bohm V, Li LC, Barnabe C, Rankin J, Hazlewood G, Marshall DA, Macmullan P, Mosher D, Homik J, English K, Tsui K, Then KL. Strategies for developing and implementing a rheumatoid arthritis healthcare quality framework: a thematic analysis of perspectives from arthritis stakeholders. BMJ Open 2021; 11:e043759. [PMID: 33674373 PMCID: PMC7938986 DOI: 10.1136/bmjopen-2020-043759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/07/2021] [Accepted: 01/26/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To obtain stakeholder perspectives to inform the development and implementation of a rheumatoid arthritis (RA) healthcare quality measurement framework. DESIGN Qualitative study using thematic analysis of focus groups and interviews. SETTING Arthritis stakeholders from across Canada including healthcare providers, persons living with RA, clinic managers and policy leaders were recruited for the focus groups and interviews. PARTICIPANTS Fifty-four stakeholders from nine provinces. INTERVENTIONS Qualitative researchers led each focus group/interview using a semistructured guide; the digitally recorded data were transcribed verbatim. Two teams of two coders independently analysed the transcripts using thematic analysis. RESULTS Perspectives on the use of different types of measurement frameworks in healthcare were obtained. In particular, stakeholders advocated for the use of existing healthcare frameworks over frameworks developed in the business world and adapted for healthcare. Persons living with RA were less familiar with specific measurement frameworks, however, they had used existing online public forums for rating their experience and quality of healthcare provided. They viewed a standardised framework as potentially useful for assisting with monitoring the care provided to them individually. Nine guiding principles for framework development and 13 measurement themes were identified. Perceived barriers identified included access to data and concerns about how measures in the framework were developed and used. Effective approaches to framework implementation included having sound knowledge translation strategies and involving stakeholders throughout the measurement development and reporting process. Clinical models of care and health policies conducive to outcome measurement were highlighted as drivers of successful measurement initiatives. CONCLUSION These important perspectives will be used to inform a healthcare quality measurement framework for RA.
Collapse
Affiliation(s)
- Claire Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Victoria Bohm
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Linda C Li
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
| | - James Rankin
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
| | - Deborah A Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
| | - Paul Macmullan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Mosher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanne Homik
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly English
- Arthritis Patient Advisory Board, Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Karen Tsui
- Arthritis Patient Advisory Board, Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
7
|
Barber CEH, Then KL, Bohm V, Hall M, Marshall DA, Rankin JA, Barnabe C, Hazlewood GS, Li LC, Mosher D, Homik J, MacMullan P, Tsui K, English K, Lacaille D. Development of a Patient-centered Quality Measurement Framework for Measuring, Monitoring, and Optimizing Rheumatoid Arthritis Care in Canada. J Rheumatol 2020; 48:326-334. [PMID: 33452175 DOI: 10.3899/jrheum.200688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to develop a patient-centered quality measurement framework to address a predefined vision statement and 7 strategic objectives for rheumatoid arthritis (RA) care that was developed in prior qualitative work with arthritis stakeholders. METHODS One hundred forty-seven RA-related performance measures (PMs) were identified from a systematic review. A candidate list of 26 PMs meeting predefined criteria and addressing the strategic objectives previously defined was then assessed during a 3-round (R) modified Delphi. Seventeen panelists with expertise in RA, quality measurement, and/or lived experience with RA rated each PM on a 1-9 scale based on the items of importance, feasibility, and priority for inclusion in the framework during R1 and R3, with a moderated discussion in R2. PMs with median scores ≥ 7 on all 3 items without disagreement were included in the final set, which then underwent public comment. RESULTS Twenty-one measures were included in the final framework (15 PMs from the Delphi and 6 published system-level measures on access to care and treatment). The measures included 4 addressing early access to care and timely diagnosis, 12 evidence-based care for RA and related comorbidities, 1 addressing patient participation as an informed partner in care, and 4 on patient outcomes. CONCLUSION The proposed framework builds upon existing measures capturing early access to care and treatment in RA and adds important PMs to promote high-quality RA care and outcome measurement. In the next phase, the authors will test the framework in clinical practice in addition to addressing certain areas where no suitable PMs were identified.
Collapse
Affiliation(s)
- Claire E H Barber
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada;
| | - Karen L Then
- K.L. Then, ACNP, CCN(C), PhD, Professor, M. Hall, MSc, CCRP, Research Associate, J.A. Rankin, ACNP, PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Victoria Bohm
- V. Bohm, MSc, MPH, Research Associate, D. Mosher, MD, FRCPC, Professor, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Marc Hall
- K.L. Then, ACNP, CCN(C), PhD, Professor, M. Hall, MSc, CCRP, Research Associate, J.A. Rankin, ACNP, PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Deborah A Marshall
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada
| | - James A Rankin
- K.L. Then, ACNP, CCN(C), PhD, Professor, M. Hall, MSc, CCRP, Research Associate, J.A. Rankin, ACNP, PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Cheryl Barnabe
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada
| | - Glen S Hazlewood
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada
| | - Linda C Li
- L.C. Li, PT, PhD, Professor, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, and Arthritis Research Canada
| | - Dianne Mosher
- V. Bohm, MSc, MPH, Research Associate, D. Mosher, MD, FRCPC, Professor, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Joanne Homik
- J. Homik, MD, FRCPC, MSc, Professor, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Paul MacMullan
- V. Bohm, MSc, MPH, Research Associate, D. Mosher, MD, FRCPC, Professor, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Karen Tsui
- K. Tsui, MScPT, ACPAC, Arthritis Patient Advisory Board (APAB) member, K. English, Arthritis Patient Advisory Board (APAB) member, Arthritis Patient Advisory Board
| | - Kelly English
- K. Tsui, MScPT, ACPAC, Arthritis Patient Advisory Board (APAB) member, K. English, Arthritis Patient Advisory Board (APAB) member, Arthritis Patient Advisory Board
| | - Diane Lacaille
- D. Lacaille, MD, FRCPC, MHSc, Professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and Scientific Director, Arthritis Research Canada
| | | |
Collapse
|
8
|
Barber CEH, Twilt M, Pham T, Currie GR, Benseler S, Yeung RSM, Batthish M, Blanchette N, Guzman J, Lang B, LeBlanc C, Levy DM, O'Brien C, Schmeling H, Soon G, Spiegel L, Whitney K, Marshall DA. A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care. Arthritis Res Ther 2020; 22:53. [PMID: 32192528 PMCID: PMC7083048 DOI: 10.1186/s13075-020-02151-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/09/2020] [Indexed: 01/22/2023] Open
Abstract
Background The evaluation of quality of care in juvenile idiopathic arthritis (JIA) is critical for advancing patient outcomes but is not currently part of routine care across all centers in Canada. The study objective is to review the current landscape of JIA quality measures and use expert panel consensus to define key performance indicators (KPIs) that are important and feasible to collect for routine monitoring in JIA care in Canada. Methods Thirty-seven candidate KPIs identified from a systematic review were reviewed for inclusion by a working group including 3 pediatric rheumatologists. A shortlist of 14 KPIs was then assessed using a 3-round modified Delphi panel based on the RAND/UCLA Appropriateness Method. Ten panelists across Canada participated based on their expertise in JIA, quality measurement, or lived experience as a parent of a child with JIA. During rounds 1 and 3, panelists rated each KPI on a 1–9 Likert scale on themes of importance, feasibility, and priority. In round 2, panelists participated in a moderated in-person discussion that resulted in minor modifications to some KPIs. KPIs with median scores of ≥ 7 on all 3 questions without disagreement were included in the framework. Results Ten KPIs met the criteria for inclusion after round 3. Five KPIs addressed patient assessments: pain, joint count, functional status, global assessment of disease activity, and the clinical Juvenile Arthritis Disease Activity Score (cJADAS). Three KPIs examined access to care: wait times for consultation, access to pediatric rheumatologists within 1 year of diagnosis, and frequency of clinical follow-up. Safety was addressed through KPIs on tuberculous screening and laboratory monitoring. KPIs examining functional status using the Childhood Health Assessment Questionnaire (CHAQ), quality of life, uveitis, and patient satisfaction were excluded due to concerns about feasibility of measurement. Conclusions The proposed KPIs build upon existing KPIs and address important processes of care that should be measured to improve the quality of JIA care. The feasibility of capturing these measures will be tested in various data sources including the Understanding Childhood Arthritis Network (UCAN) studies. Subsequent work should focus on development of meaningful outcome KPIs to drive JIA quality improvement in Canada and beyond.
Collapse
Affiliation(s)
- Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marinka Twilt
- Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Tram Pham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gillian R Currie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Susanne Benseler
- Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Rae S M Yeung
- Departments of Pediatrics, Immunology and Medical Science, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle Batthish
- Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada
| | - Nicholas Blanchette
- The Hospital for Sick Children, Toronto, ON, Canada.,Trillium Health Partners, Mississauga, ON, Canada
| | - Jaime Guzman
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bianca Lang
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Claire LeBlanc
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Deborah M Levy
- Departments of Pediatrics, Immunology and Medical Science, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Heinrike Schmeling
- Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Gordon Soon
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Lynn Spiegel
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Deborah A Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
9
|
Johansen I, Klokkerud M, Anke A, Børke JB, Glott T, Hauglie U, Høyem A, Klovning A, Lande KA, Larsen M, Nordvik JE, Wigers SH, Øyeflaten I, Hagen KB, Kjeken I. A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; development and pilot testing. BMC Health Serv Res 2019; 19:265. [PMID: 31036000 PMCID: PMC6489243 DOI: 10.1186/s12913-019-4091-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Systems for monitoring effectiveness and quality of rehabilitation services across health care levels are needed. The purpose of this study was to develop and pilot test a quality indicator set for rehabilitation of rheumatic and musculoskeletal diseases. Methods The set was developed according to the Rand/UCLA Appropriateness Method, which integrates evidence review, in-person multidisciplinary expert panel meetings and repeated anonymous ratings for consensus building. The quality indicators were pilot-tested for overall face validity and feasibility in 15 specialist and 14 primary care rehabilitation units. Pass rates (percentages of “yes”) of the indicators were recorded in telephone interviews with 29 unit managers (structure indicators), and 164 patients (process and outcome indicators). Time use and participants’ numeric rating of face validity (0–10, 10 = high validity) were recorded. Results Nineteen structure, 12 process and five outcome indicators were developed and piloted. Mean (range) sum pass rates for the structure, process and outcome indicators were 59%(84%), 66%(100%) and 84%(100%), respectively. Mean (range) face validity score for managers/patients was 8.3 (8)/7.9 (9), and mean answering time was 6.0/5.5 min. The final indicator set consists of 19 structure, 11 process and three outcome indicators. Conclusion To our knowledge this is the first quality indicator set developed for rehabilitation of rheumatic and musculoskeletal diseases. Good overall face validity and a feasible format indicate a set suitable for monitoring quality in rehabilitation. The variation in pass rates between centers indicates a potential for quality improvement in rheumatic and musculoskeletal rehabilitation in Norway. Electronic supplementary material The online version of this article (10.1186/s12913-019-4091-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Inger Johansen
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway. .,Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Norway.
| | - Mari Klokkerud
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Janne-Birgitte Børke
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Thomas Glott
- Sunnaas Rehabilitation Hospital, 1453, Bjørnemyr, Norway
| | - Uno Hauglie
- The Municipality of Sandefjord, PO Box 2025, 3202, Sandefjord, Norway
| | - Audhild Høyem
- Centre for Quality Improvement and Development, University Hospital of North Norway, Box 20, N-9038, Tromsø, Norway
| | - Atle Klovning
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Norway
| | | | - Mona Larsen
- Norwegian Rheumatism Association, PO Box 2653, Solli, N-0203, Oslo, Norway
| | | | - Sigrid H Wigers
- Unicare Jeløy Rehabilitation Centre, Bråtengaten 94, N-1515, Moss, Norway
| | - Irene Øyeflaten
- National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20. 3864, Rauland, Norway.,Uni Research Health, Nygårdsgaten 112, 5008, Bergen, Norway
| | - Kaare Birger Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway
| |
Collapse
|