Background/Purpose: A QI set for systemic lupus erythematosus (SLE) was developed in the United States. However, this does not necessarily conform to the Japanese medical condition. Instead, they could be a burden to the estimators because they need to look up the medical chart records. The aim of this study was to develop a QI set systematically for Japanese SLE patients that we can evaluate easily using electronic health data.

Methods: We used a validated process that combined available scientific evidence and expert consensus to develop a QI set for SLE. First, we performed a literature review to retrieve all clinical practice guidelines (CPGs) and QI development studies that are relevant to SLE by using the Ovid MEDLINE and Elsevier EMBASE databases. The CPGs were defined as follows: ① organizing the panel committee, ② implementation of the literature review, and ③ implementation of the grading quality of evidence and strength of recommendations. Second, we extracted the candidate QI items that can be evaluated by using electronic health data (administrative and laboratory data) from the final selected literature. Third, we used a modification of the RAND/UCLA Appropriateness Method. An interdisciplinary expert panel that comprised seven rheumatologists, one primary care physician, one dermatologist, and one obstetrician convened to discuss the evidence and provide final ratings on the appropriateness. Before the face-to-face meeting, we shared via e-mail the rating sheet and documents that summarized the scientific evidence to panelists and asked them to rate the appropriateness of each QI (the first round of rating). At the face-to-face meeting, each panelist received an anonymous summary of the rankings by the other members of the group. The discussion was aimed at determining whether different ratings resulted from real clinical disagreement. After several minor revisions, the panelists re-rated the appropriateness of each item by using the same scale (the second round of rating).

Results: We found 3621 articles through the initial search. After the title and abstract screening, 224 articles were further analyzed. Finally, four literatures on CPGs and 30 studies on QI development were identified. Seventeen potential indicators were extracted as candidate QI items from these literatures. Ten expert panel members evaluated the 17 potential indicators in the first round of rating and face-to-face meeting among the panelists and then excluded three indicators. At the second round of rating, the panelists re-rated the appropriateness of the 14 items and removed two items. Accordingly, we selected the remaining 12 indicators as the final QI set. The median appropriateness of these 12 indicators was at least 7.5, and the percentage of agreement of all the items exceeded 80%. The areas covered included assessment of disease activity, treatment, and drug toxicity monitoring. All the indicators can be measured by using existing electronic health data alone, without medical record review, and all are process indicators.

Conclusion: We identified 12 QIs for assessment of SLE patients based on administrative data. This study may contribute to the spread of QIs in the area of rheumatology in Japan.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-of-quality-indicator-set-of-systemic-lupus-erythematosus-in-japan/