Background/Purpose: Quality measures are metrics health professionals can monitor to improve care delivery and patient outcomes. To be measurable they must include a specified numerator, denominator for a defined population, capture best-practices and be feasible to measure. The objective of this study was to conduct a systematic review and quality appraisal of measures for inflammatory arthritis (IA).

Methods: A search strategy was developed in consultation with a medical librarian using MeSH terms for IA (SpA [AS, PsA, ReA, and IBD-related arthritis], RA, and JIA) and quality measures. EMBASE, MEDLINE and CINAHL were searched from January 1, 2000 to Jan 17, 2016. A “grey literature” review of international arthritis organizations and quality measure libraries was also conducted. Two reviewers independently considered the papers for inclusion with disagreements resolved by consensus. A modified guideline appraisal tool (AGREE-II) was used to evaluate 6 domains of measure development on a 7 point Likert scale: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence and an overall quality assessment which determined inclusion. Measures were abstracted in duplicate and categorized into themes, indicator type (process, structure, outcome) and based on 6 domains of quality (acceptability, accessibility, appropriateness, effectiveness, efficiency, safety).

Results: 3417 unique citations were found and 483 were selected for full-text review, 8 measurement sets were eligible for inclusion. An additional 2 sets were included that were published after the search and 5 sets from the grey literature review. Two sets did not meet AGREE II criteria leaving a total of 13 measurement sets. The measure sets were from 4 countries (USA, Canada, UK, Netherlands) and one European consortium. They included 10 sets on RA and 1 each for PsA, IA and JIA. There were a total of 161 unique individual measures (136 process, 20 structure and 5 outcome). Measures were found covering each of the 6 domains of quality. Frequent themes included assessment, management (including medications and comorbidities), wait times and education. Measure sets were developed based on systematic reviews of guidelines and measures, individual guidelines or on information from targeted literature reviews. Evaluation of development methods for the measurement sets revealed a variety of consensus techniques including: RAND-UCLA appropriateness methodology, prioritization exercises or other modified-Delphi methods. Inclusion of patients occurred in 62% of development groups. Discussion of barriers to measurement was infrequent.

Conclusion: This review highlights that IA quality measures cover a diversity of themes encompassing process, structure and outcome measures across the 6 domains of quality. However, between organizations measure development is not standardized, highlighting the need for a standardized assessment tool for evaluation of development methods. As well, local assessment of measurement feasibility through pilot testing before implementation and use outside the original development context is recommended.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systematic-review-and-appraisal-of-quality-measures-for-inflammatory-arthritis/