Measuring Different Care Approaches for Rheumatoid Arthritis



Scientific Study Title:

Testing of System-Level Performance Measures for Inflammatory Arthritis


Study Start Date:


End Date:



Why Did We Do This Research?

Over one million Canadians have inflammatory arthritis (IA). There are a few types of IA, but the most common type in adults is rheumatoid arthritis (RA). Early access to the right treatment for patients with RA can improve their outcomes, reducing their symptoms and improving their quality of life. However, in many regions of Canada, it is challenging to provide high-quality care in a timely way because there are too few rheumatologists. In response to this, the Arthritis Alliance of Canada (AAC), an organization of over 36 Canadian arthritis groups, developed ‘Models of Care for Inflammatory Arthritis’. The Models of Care highlight best practices for early diagnosis and treatment using a set of quality measures. We did this research study with the AAC to see how well different healthcare models for patients with RA were doing in meeting four key quality measures.


What Did We Do?

We evaluated how well RA care is managed across five Canadian clinical sites in Newfoundland, Ontario, and Alberta, including two sites serving Indigenous populations. We looked at four quality measures:
1) how long patients waited to see a rheumatologist,
2) how many patients had yearly follow-up appointments,
3) how many patients were taking medications known to slow down the disease (called disease-modifying antirheumatic drugs or DMARDs), and
4) how quickly patients started on DMARD therapy after being diagnosed.


What Did We Find?

We had some challenges in figuring out how well different care models were doing because not all of them kept track of their data in the same way, or for long enough. For example, not all models had complete records about how long patients waited to see a rheumatologist. The waiting time was very different among the sites, from 21 to 75 days. Only two sites could tell us how many of their patients came back for yearly check-ups. Those rates were between 83% and 100%. When it came to patients taking DMARDs and how quickly they started taking them after diagnosis, only three sites provided enough information to evaluate. This data showed 90% to 100% of patients on DMARDs and median time to start these drugs was zero days.

This study consists of 4 sub-projects dedicated to achieving our overall goals. Click below for more information about each sub-project:



Research Team

Principal Investigator:

Claire Barber, MD, PhD, FRCPC; Research Scientist, Arthritis Research Canada (University of Calgary)


Diane Lacaille, MD, FRCPC, MHSc, Scientific Director, Arthritis Research Canada (University of British Columbia)

Cheryl Barnabe, MD, MSc, FRCPC,  Senior Scientist, Arthritis Research Canada  (University of Calgary)

Deborah Marshall, PhD, Senior Scientist, Arthritis Research Canada (University of Calgary)

Susanne Benseler, MD, Research Scientist, Arthritis Research Canada (University of Calgary)

Glen Hazlewood, MD PhD FRCPC, Research Scientist, Arthritis Research Canada (University of Calgary)

Dianne Mosher (University of Calgary)

Vivian Bykerk  (Weill Cornell University)

Jennifer Burt (St. Clare’s Mercy Hospital)

Carter Thorne (University of Toronto),

Vandana Ahluwalia (William Osler Health System)

Lisa Denning (William Osler Health System)

Natalie Shiff (University of Florida Health)

Steven Katz (University of Alberta)

Joanne Homik (University of Alberta)



Who Funded the Research?

This study was funded by the Canadian Initiative for Outcomes in Rheumatology Care (CIORA).


Related Publication:

  • Barber CEH, Thorne JC, Ahluwalia V, Burt J, Lacaille D, Marshall DA, Hazlewood GS, Mosher D, Denning L, Szamko I, Chin R, Hamilton S, Benseler S, Twilt M, Shiff NJ, Bykerk V, Homik J, Barnabe C. (2018). Feasibility of Measurement and Adherence to System Performance Measures for Rheumatoid Arthritis in 5 Models of Care. The Journal of rheumatology, 45(11), 1501–1508. https://doi.org/10.3899/jrheum.171284