A population-based approach to reporting system-level performance measures for rheumatoid arthritis care.
OBJECTIVE: To operationalize and report on nationally endorsed rheumatoid arthritis (RA) performance measures (PMs) using health administrative data for British Columbia (BC), Canada.
METHODS: All BC RA patients age ≥18 were identified between 01/01/1997 and 31/12/2009 using health administrative data and followed until December 2014. PMs tested include: the percentage of incident cases with ≥1 rheumatologist visit within 365 days (d); the percentage of prevalent cases with ≥1 rheumatologist visit per year; the percentage of prevalent cases dispensed DMARD therapy; and time from RA diagnosis to DMARD therapy. Measures were reported on patients seen by rheumatologists, and in the total population.
RESULTS: The cohort included 38673 incident and 57922 prevalent RA cases. The percentage of patients seen by a rheumatologist within 365d increased over time: 35% in 2000 to 65% in 2009, while the percentage of RA patients under the care of a rheumatologist seen yearly declined: 79% in 2001 to 39% in 2014. The decline was due to decreasing visit rates with increasing follow-up time rather than calendar effect. The percentage of RA patients dispensed a DMARD was suboptimal over follow-up (37% in 2014) in the total population but higher (87%) in those under current rheumatologist care. The median time to DMARD in those seen by a rheumatologist improved from 49d in 2000 to 23d in 2009, with 34% receiving treatment within the 14d benchmark.
CONCLUSIONS: This study describes the operationalization and reporting of national PMs using administrative data and identifies gaps in care to further examine and address.