Donate Now
  • Research Completed
Improving Quality of Care for Rheumatoid Arthritis
View in English
Voir en francais
Rheumatoid-Arthritis-2.0-1

Scientific Study Title:

Developing a patient-centered balanced scorecard approach for rheumatoid arthritis.

Start Date: 

  • 2017

End Date:

  • 2021

Research Category

Tags

Claire Barber
Research Scientist, Rheumatology, MD, PhD, FRCPC
Diane Lacaille
MDCM, MHSc, FRCPC, Scientific Director, Rheumatology

Ready to Participate?

Life-changing arthritis research is only possible with your help!

Participate Now

Why do this research?

Reason For Research

In Canada, the quality of care for patients with inflammatory arthritis is not routinely monitored. As a result, there may be variations in care that could lead to poor patient outcomes. Inflammatory arthritis conditions cause joint pain, swelling, and deformity, leading to disability. Rheumatoid arthritis is the most common type found among adults.

One approach to monitoring and improving the quality of care provided to patients is the implementation of a balanced scorecard. Like a report card, a balanced scorecard is a structured approach to improving care efficiency and performance that represents viewpoints from multiple stakeholder perspectives. In this case, the knowledge users and interest holders include people living with arthritis, healthcare providers, healthcare managers and policy makers. A key part of this approach is that performance data is reported back to clinics and health care providers, so they can work on improving things where performance was not optimal. This feedback is critical, as we cannot improve what we don’t measure.

Methodology

Execution of Research

The research study included three phases.

Phase One was conducted in collaboration with the Arthritis Alliance of Canada (AAC) and the Canadian Rheumatology Association (CRA). A series of focus groups and interviews were held with people living with arthritis, physicians, allied health providers, healthcare managers and policymakers. The purpose of phase one was to understand what is necessary for providing high-quality care for people with rheumatoid arthritis in Canada.

In Phase Two, the aim was to create a scorecard for measuring the quality of care for rheumatoid arthritis that aligned with findings from Phase One. First, a systematic review was conducted to identify existing quality measures in rheumatoid arthritis care and map them according to the findings in Phase One. Second, a group of experts in the field of performance measurement and two patient partners were brought together to finalize the measures to be included in the scorecard. These measures were used to inform Phase Three.

Phase Three was conducted in collaboration with the Alberta Medical Association’s Physician Learning Program. First, five quality measures that focus on treating rheumatoid arthritis according to ‘treat-to-target’ principles were selected from the 21 measures identified in phase two. The five measures included regular follow-ups, documenting disease activity, timely appointments for non-remission patients, achieving low disease activity, and remission rates. Then, the measures were tested and put into action in real-life rheumatology clinics and were reported on by physicians via ‘practice reports’. This research also captured how rheumatologists felt about receiving personalized reports on their performance. Data was collected using Rheum4U, an online platform for quality improvement and research.

Findings & Next Steps

In phase one, a total of 54 interest holders from nine Canadian provinces participated in the study. Seven key areas that are critical for high-quality rheumatoid arthritis care were identified:

  1. Early access and timely care: Getting rheumatoid arthritis patients the care they need quickly.
  2. Evidence-based, high-quality ongoing care: Using the best available knowledge to manage rheumatoid arthritis and any other health issues.
  3. Patient self-management and shared decision-making: Providing tools and information to patients in a timely manner so they can manage their care and make informed decisions together with healthcare providers.
  4. Multidisciplinary care: Involving a team of different healthcare professionals to address all aspects of rheumatoid arthritis.
  5. Patient outcomes: Focusing on improving health outcomes for rheumatoid arthritis patients.
  6. Patient experience and satisfaction: Ensuring patients are satisfied with their care experience.
  7. Equity: Making sure that all rheumatoid arthritis patients, regardless of their background or location, receive high-quality care.

Phase One identified a vision statement: “Ensuring patient-centered, high-quality care for people living with rheumatoid arthritis.”

In Phase Two, the systematic review revealed 147 rheumatoid arthritis-related quality measures. After the Delphi study, a total of 21 quality measures were identified – called the RA Quality Improvement Framework, to inform the quality report card/reporting. These measures were categorized into four main areas: early access to care and timely diagnosis (4 measures), evidence-based care for arthritis and related conditions (12 measures), patient participation as an informed partner in their care (1 measure), and patient outcomes (4 measures).

In phase three, eleven rheumatologists participated in receiving the practice reports. A total of 448 patient records from two university-affiliated rheumatology clinics were included in the data for the practice reports. The reports revealed excellent rates of yearly follow-ups and documentation of patient disease activity. However, opportunities were identified for improvement. These included increasing the percentage of patients seen promptly, if not in remission, and working to improve remission rates. Feedback from rheumatologists indicated that they found the audit and feedback process valuable, particularly in comparing their performance to peers. Rheumatologists suggested several strategies for improvement, including using electronic records for future reports, providing more detailed results, and using high-performing peers as benchmarks rather than group averages.

The next steps of this research include conducting a larger evaluation of these types of quality improvement initiatives. We are currently working with our health systems to develop in-system quality reporting through dashboard displays to support teams to optimize care.

Related Publications

Related Research

New Model of At-Home Follow-Up Care_PLS

A New Model of At-Home Follow-Up Care for Rheumatoid Arthritis

Read More
Kinesiologists-and-Exercise-Physiologists-PLS-Feature-Image-425x296-1

Preparing kinesiologists and exercise physiologists: what does this mean for arthritis care?

Read More
Ozempic-PLS-Feature-Image-425x296-1

Are medications like Ozempic safe and effective for people with inflammatory arthritis and type 2 diabetes?

Read More
Research-Stream-AI-Study_425x296

Using Artificial Intelligence to Streamline Research on Rheumatoid Arthritis Treatments

Read More
2026-Studies-to-Watch-Decision-Aid

Evaluating a Decision Aid for Tapering Biologic Medications in Rheumatoid Arthritis

Read More
Research-EDI-Study_425x296

Improving Equity, Diversity, and Inclusion (EDI) in Arthritis Research

Read More