Understanding Rheumatoid Arthritis Care in British Columbia and Alberta



Scientific Study Title:

Testing of System-Level Performance Measures for Inflammatory Arthritis


Study Start Date:


End Date:



Why Did We Do This Research?

Early and targeted treatment methods for rheumatoid arthritis (RA) can greatly improve patient outcomes. The Arthritis Alliance of Canada (AAC) highlights the importance of a continuum of RA care, from early diagnosis to ongoing treatment. The AAC developed a method to test the success of care models. It focuses on access to care and early treatment, using a set of quality measures. This study aimed to assess the effectiveness of RA care in two Canadian provinces, British Columbia (BC) and Alberta by looking at four system-level quality measures.


What Did We Do?

Two research studies were done. One explored RA care in Alberta and one explored RA care in BC. In both provinces, researchers identified people diagnosed with RA using provincial health administrative data. The study periods looked at different years. The BC data focused on patients from 1997 to 2009 and followed up until 2014. The Alberta data included patients from 2012/13 to 2015/16. The quality of care measures were:
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?

Timeliness and Frequency of Seeing Rheumatologists: For both provinces, the percentage increased for newly diagnosed RA patients seeing a rheumatologist within a year. However, rates for annual follow-up with rheumatologists dropped in BC and varied in Alberta.

DMARD Therapy: In BC, the use of DMARDs was less than ideal across the total population but higher among patients under rheumatologist care. Alberta had a consistently low yearly rate of dispensing DMARDs. There were slight improvements in the median time for how quickly patients began DMARD therapy but failure to meet the 14-day mark for a large number of patients.

Gaps in Care: Both studies showed gaps in RA care, including barriers to seeing rheumatologists and getting DMARD therapy. Despite some improvements, care in both provinces falls short of national standards. This shows a need for quality improvement efforts.

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 Publications:

  • Barber CEH, Lacaille D, Faris P, Mosher D, Katz S, Patel JN, Zhang S. Yee K, Barnabe C, Hazlewood GS, Bykerk V, Shiff NJ, Twilt M, Burt J, Benseler, S. M., Homik J, Marshall DA. (2021). Evaluating Quality of Care for Rheumatoid Arthritis for the Population of Alberta Using System-level Performance Measures. The Journal of rheumatology, 48(4), 482–485. https://doi.org/10.3899/jrheum.200420


  • Barber CEH, Marshall DA, Szefer E, Barnabe C, Shiff NJ, Bykerk V, Homik J, Thorne JC, Ahluwalia V, Benseler S, Mosher D, Twilt M, Lacaille D (2021). A Population-Based Approach to Reporting System-Level Performance Measures for Rheumatoid Arthritis Care. Arthritis care & research, 73(5), 640–648. https://doi.org/10.1002/acr.24178