title: Performance on rheumatoid arthritis quality indicators in an Alaska Native healthcare system.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) is highly prevalent in some Alaska Native and American Indian populations. Quality indicators for RA have been proposed, but these have not been widely implemented or used to assess RA care in Alaska Native or American Indian populations.
  
  
  METHODS
  Medical records were included if they met the following criteria: RA diagnosed before October 2000 fulfilling American College of Rheumatology classification criteria; all care for RA at the Alaska Native Medical Center. Records were reviewed for a 5-year period to determine compliance with eight quality indicators defined by the Arthritis Foundation Quality Indicator Program. Multivariate logistic regression was performed to analyse associations with quality of care.
  
  
  RESULTS
  There were 106 individuals included in the study. The highest-scoring measures were folic acid prescription if on methotrexate (93.3%) and disease-modifying antirheumatic drug prescription (90.6%). The lowest scoring measure was radiographs of both hands and feet (16.0%). In multivariate analysis, the factor most strongly associated with disease-modifying antirheumatic drug prescriptions, annual exam for RA and hand radiographs was at least one visit with a rheumatologist.
  
  
  CONCLUSIONS
  Quality of care for RA varies by measure and is better for patients who see a rheumatologist. These data provide an initial evaluation of RA quality of care in a unique minority population with an integrated healthcare system.
authors.affiliation: Alaska Native Tribal Health Consortium, 4315 Diplomacy Drive, ANC-HEP, Anchorage, AK 99508, USA. edferucci@anmc.org
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Ferucci
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Donnithorne
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Koller
authors.forename: Amy
authors.initials: A
authors.lastname: Swango-Wilson
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Pflaum
authors.forename: Anne P
authors.initials: AP
authors.lastname: Lanier
mesh_terms: D000328:Adult; D000413:Alaska; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D006303:Health Services, Indigenous; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D019984:Quality Indicators, Health Care