Dr. MacLean is recipient of a Veterans Affairs Health Services Research and Development Career Development award.
Application of explicit process of care measurement to rheumatoid arthritis: Moving from evidence to practice
Version of Record online: 30 NOV 2006
Copyright © 2006 by the American College of Rheumatology
Arthritis Care & Research
Volume 55, Issue 6, pages 884–891, 15 December 2006
How to Cite
Kahn, K. L., Maclean, C. H., Liu, H., Rubenstein, L. Z., Wong, A. L., Harker, J. O., Chen, W. P., Fitzpatrick, D. M., Bulpitt, K. J., Traina, S. B., Mittman, B. S., Hahn, B. H. and Paulus, H. E. (2006), Application of explicit process of care measurement to rheumatoid arthritis: Moving from evidence to practice. Arthritis & Rheumatism, 55: 884–891. doi: 10.1002/art.22361
- Issue online: 30 NOV 2006
- Version of Record online: 30 NOV 2006
- Manuscript Accepted: 29 MAR 2006
- Manuscript Received: 9 FEB 2006
- NIH. Grant Number: 5 P60-AR-36834
- University of California
- Los Angeles Multipurpose Arthritis and Musculoskeletal Disease Center
- Rheumatoid arthritis;
- Quality of care
To construct quality measures with measurement validity and meaning for clinicians.
We conducted a prospective cohort study of rates of change in disease-modifying antirheumatic drug (DMARD) and/or systemic corticosteroid drug or dose for 568 patients with rheumatoid arthritis (RA) across 6,159 clinical encounters within 12 months to examine how changes in clinical specifications change adherence.
Rates of DMARD change were sensitive to specifications regarding the intensity of disease activity (severe or moderate), duration of specified disease activity, and length of the observation period. Over 12 months, the proportions of 377 patients with severe disease activity observed for 1-month, 2-month, and 3-month time blocks who had a change in DMARD drug or dose were 36%, 57%, and 74%, respectively. Over 12 months, a change in DMARD drug or dose was observed for 44%, 50%, and 68% of 377 patients with severe disease within 3 months, 6 months, and 12 months, respectively, of the patient meeting criteria for severe disease activity. A change in DMARD drug or dose was observed for 21%, 23%, and 34% of 149 patients with moderate disease activity within 3, 6, and 12 months, respectively, of the patient meeting criteria for moderate disease activity.
Rates of pharmacologic interventions for patients with moderate and severe RA disease activity vary substantially by intensity and duration of disease activity and by duration of period for observing change. Lack of precision in explicit process criteria could substantially mislead comparisons of quality of care across comparison groups.