title: Assessing process of care in rheumatoid arthritis at McGill University hospitals.
abstract: OBJECTIVE
  In rheumatoid arthritis (RA), quality indicators (QIs) are tools used to measure process of care. This study aimed to assess performance of selected QIs from the 2004 Arthritis Foundation's QI Set at 2 major sites of a university network of teaching hospitals.
  
  
  METHODS
  The charts and electronic hospital records of 76 RA patients were audited to determine adherence to QIs. Logistic multivariate regression analyses were performed to investigate potential determinants of nonadherence and propose measures to facilitate better QI compliance, as a potential strategy towards RA care improvement.
  
  
  RESULTS
  We identified consistent observance of QIs mandating prescription of disease-modifying antirheumatic drug therapy for all patients, drug adjustment with disease activity, prednisone tapering, and bisphosphonate therapy if indicated for patients on glucocorticoids. However, there was either lack of documentation or true inconsistent adherence to QIs dealing with radiograph performance, functional capacity assessment, and screening for hepatitis and tuberculosis before commencement of methotrexate and biologic agents, respectively. For the specific QIs analyzed, we did not find any definite independent associations with the studied variables.
  
  
  CONCLUSIONS
  Our findings indicate that while there is frequent evidence for adherence to certain RA quality care standards at our centers, there is less compliance to others. Strategies to optimize the performance or documentation of those found most lacking, namely, functional capacity and screening for specific drug contraindications, could improve patient care. Radiographic disease monitoring, while lacking, may represent a move toward other more sensitive methods of RA progression detection, such as joint ultrasound. The inclusion of patient- and physician-derived information could help elucidate the reasons underlying nonadherence.
authors.affiliation: Division of Rheumatology, McGill University, Montréal, Quebec, Canada.
authors.forename: Lisa Marina
authors.initials: LM
authors.lastname: Li
authors.forename: Basile
authors.initials: B
authors.lastname: Tessier-Cloutier
authors.forename: Yafei
authors.initials: Y
authors.lastname: Wang
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.forename: Evelyne
authors.initials: E
authors.lastname: Vinet
authors.forename: Henri André
authors.initials: HA
authors.lastname: Ménard
authors.forename: Pantelis
authors.initials: P
authors.lastname: Panopalis
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hazel
authors.forename: Michael
authors.initials: M
authors.lastname: Stein
authors.forename: Martin
authors.initials: M
authors.lastname: Cohen
authors.forename: Michael
authors.initials: M
authors.lastname: Starr
authors.forename: Christian
authors.initials: C
authors.lastname: Pineau
authors.forename: Marie-Ève
authors.initials: MÈ
authors.lastname: Veilleux
authors.forename: Inés
authors.initials: I
authors.lastname: Colmegna
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000628:therapy*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D054869:Clinical Audit; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D005529:Foot Bones / Q000000981:diagnostic imaging; D005938:Glucocorticoids / Q000627:therapeutic use; D050276:Hand Bones / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D010808:Physical Examination / Q000706:statistics & numerical data; D011241:Prednisone / Q000008:administration & dosage; D019984:Quality Indicators, Health Care; D011792:Quebec; D011859:Radiography / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D061665:Time-to-Treatment / Q000706:statistics & numerical data
chemical_list: D018501:Antirheumatic Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D002097:C-Reactive Protein; D011241:Prednisone