Background/Purpose: To identify published quality measures in rheumatoid arthritis (RA), osteoarthritis (OA), osteoporosis, spondyloarthropathy (SpA) and gout for the purpose of summarizing the existing measures and identifying gaps for improving care.  

Methods: We performed a systematic review of English language articles in PubMed and Embase published before 2/11/2016 on the topic of quality measures in RA, OA, osteoporosis, SpA (psoriatic arthritis and ankylosing spondylitis) and gout. To be included, the quality measure applied to a clearly stated study population and had a description of its development, a measurable change, and an identifiable numerator and denominator. When articles referenced a website as the primary source of a quality measure, we reviewed the website for additional references; opinion articles were excluded. If measures were published on an annual basis, we evaluated the most recent measure set. We categorized individual measures by disease, publication year, domain (structure, process or outcome), country of origin, and endorsement.  We analyzed identified quality measures across disease categories to draw summative conclusions and identify gaps.

Results: The literature search identified 4831 relevant abstracts.  Detailed screening by 3 reviewers identified 22 abstracts meeting the inclusion criteria; 6 quality measure sets were found only on websites with no primary source in the scientific literature. Most of the published measures were specific for RA and OA (Table) and published after 2010 (n = 24, 62%).  Not unexpectedly, most of the measures were related to the health care delivery process (82.3%), while relatively few were in the domains of structure (16%) and outcome (1.7%). Quality measures often originated from organizations and investigators in the United States (US) and United Kingdom (UK). Within the US, ACR (3 sets), Centers for Medicare and Medicaid Services (CMS) (3 sets), and the National Committee for Quality Assurance (NCQA) (2 sets) produced the greatest number of measure sets.

Conclusion:  Most of the quality measures in rheumatology relate to the care of patients with RA and OA and focus on process rather than outcomes or structure.  These results highlight the gaps in our ability to measure quality of care across the full spectrum of common rheumatologic diseases.  Further work is needed to expand the development of quality measures to other common rheumatologic diseases and to address quality of care from the perspective of structure and outcomes.

Quality measures by High Priority Rheumatologic Disease

*Only one paper found for spondyloarthropathy, specifically addressing psoriatic arthritis. ^# Generic Inflammatory arthritis includes: RA, psoriatic arthritis, ankylosing spondylitis and juvenile idiopathic arthritis US = United States; UK = United Kingdom; EULAR = European League Against Rheumatism; PANLAR = Pan American League of Associations of Rheumatology