Background/Purpose: Early diagnosis, treatment and ongoing care are critical to optimize RA outcomes. The purpose of the study was to evaluate key elements of RA quality of care using 4 Arthritis Alliance of Canada performance measures (PMs) in Alberta, Canada: PM1) Waiting times for rheumatologist consultation for RA; PM2) Percentage of RA patients with at least one visit to a rheumatologist in the first year of diagnosis; PM3) Percentage of RA patients dispensed a disease modifying anti-rheumatic drug (DMARD); PM4) Time to DMARD initiation.

Methods: All prevalent RA cases 16 years and older between 2002/03 and 2016/17 in AB were defined using 2 or more physician billing codes at least 8 weeks apart and within a 2-year period, or 1 or more hospitalization codes for RA in health administrative data. PMs were estimated through linked datasets for fiscal years 2012-2015. PM1: The wait time in days (d) between referral and first appointment were calculated through linkage with central rheumatology triage databases in two sites. PM2: The percentage of incident RA cases with at least one visit to a rheumatologist within one year of their first RA code. PM3: The percentage of prevalent RA patients dispensed a DMARD (including conventional DMARDs, biologic agents and small molecule inhibitors) was calculated through linkage to a pharmacy database. PM4: Time from RA referral to DMARD dispensation was reported in the calendar year of RA incidence.

Results: The PMs are reported in Table 1 by year and by site where appropriate based on available data sources needed to calculate some measures. Median wait times for rheumatology consultation (PM1) were longer in Site 1 than in Site 2 with between 9-28% meeting the 28-day benchmark in Site 1 and 21-37% in Site 2. Between 2012-2015 the percentage of RA incident cases seen by a rheumatologist within 1 year of onset (PM2) increased from 55 to 63%; however, during this time period the percentage of patients dispensed DMARD therapy (PM3) remained sub-optimal at approximately 40%. Median time to DMARD from referral also suboptimal (PM4).

Conclusion: RA patients in Alberta continue to experience long waiting times to care and treatment with up to 37% of suspected RA cases not seeing a rheumatologist within 1 year of onset. Furthermore, only 40% of RA patients are on DMARD therapy. Further research is warranted to evaluate predictors of adherence to the PMs and to determine the impact on patient outcomes.

Table 1. Performance on 4 AAC System-Level Performance Measures for RA in Alberta, Canada