title: Quality of care for gout in the US needs improvement.
abstract: OBJECTIVE
  To examine evidence-based quality indicators (QIs) in US veterans with gout diagnosis, and to examine the effect of demographics, heath care utilization/access, comorbid conditions, or physican characteristics as predictors of quality of gout care.
  
  
  METHODS
  Using the Minneapolis Veterans Affairs electronic medical record system, we identified a cohort of veterans receiving medication to treat gout between January 1, 1999 and December 31, 2003, and evaluated 3 recently published evidence-based QIs for gout management: QI 1 = allopurinol dose <300 mg in gout patients with renal insufficiency, QI 2 = uric acid check within 6 months of starting a new allopurinol prescription, and QI 3 = complete blood count and creatine kinase check every 6 months for gout patients receiving prolonged colchicine therapy. We calculated the proportion of patients whose therapy adhered to each QI and to all applicable indicators (overall physician adherence). Logistic regression analysis examined association of overall physician adherence with sociodemographics, health care utilization, comorbidity, and provider characteristics.
  
  
  RESULTS
  Of 3,658 patients with a diagnosis of gout, 663 patients qualified for examination of >/=1 QI. Of these 663 patients, therapy in only 144 (22%) adhered to all applicable QIs; 59 (78%) of 76 adhered to QI 1, 155 (24%) of 643 adhered to QI 2, and 18 (35%) of 52 adhered to QI 3. Overall physician adherence to QIs was significantly lower in older veterans and in those with more inpatient visits per year, but was higher in those with more primary care visits or more health care providers.
  
  
  CONCLUSIONS
  Suboptimal physician adherence to QIs was seen for all 3 QIs tested in this cohort of veterans with gout. These findings can guide quality improvement efforts.
authors.affiliation: Minneapolis VA Medical Center, University of Minnesota, Minneapolis 55417, USA. Jasvinder.Singh@med.va.gov
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.forename: James S
authors.initials: JS
authors.lastname: Hodges
authors.forename: John P
authors.initials: JP
authors.lastname: Toscano
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use; D001772:Blood Cell Count; D003078:Colchicine / Q000627:therapeutic use; D015897:Comorbidity; D003402:Creatine Kinase / Q000097:blood; D019317:Evidence-Based Medicine; D005260:Female; D006073:Gout / Q000188:drug therapy* / Q000453:epidemiology; D006074:Gout Suppressants / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D017410:Practice Guidelines as Topic / Q000592:standards; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000097:blood / Q000175:diagnosis; D014527:Uric Acid / Q000097:blood; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol; D003402:Creatine Kinase; D003078:Colchicine