title: From the model of integral attention to the creation of centers of excellence in rheumatoid arthritis.
abstract: For the Pan American Health Organization (PAHO), the care of patients with chronic diseases currently experiences fragmentation in attention, generating poor performance of health services. Thus, comprehensive health care strategies arise to mitigate these problems; one of them are Centers of Excellence (CoEs), which aim to obtain high quality results in health from the adequate and minimum use of resources. The objective of this study was to describe the history and current context of the CoE in comprehensive care in patients with rheumatoid arthritis (RA). A systematic search of the literature terms (MeSH) was performed. The bases used were PubMed, Ebsco Host, Lilacs, Science Direct, Ovid, and Google (gray literature). The source of the information was evaluated to determine its quality. International standards focus the CoEs starting from comprehensive management of patients with RA and patient volume, continuous improvement, and quality of health care, constituting an interdisciplinary team. The REAL-PANLAR group suggested that the inclusion of the strategy "Treat to Target", and patient education improves patient conditions and understanding of the disease. RA is a prevalent and costly disease. The creation of comprehensive care centers of the CoE type is an initiative that improves the prognosis of RA. This document aims to encourage rheumatologists and scientific societies to structure CoE in an interdisciplinary endeavor.
authors.affiliation: BIOMAB: Rheumatoid Arthritis Center, Calle 48 N 13-86, Bogotá, Colombia. pedrivansamo@hotmail.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Santos-Moreno
authors.affiliation: Clinica Anglo-Americana, Lima, Peru. ocastaneda@yahoo.com.
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Castañeda
authors.affiliation: Clinica Ricardo Palma and Osteoporosis Center, Lima, Peru. bgarrob1@yahoo.es.
authors.forename: Boris
authors.initials: B
authors.lastname: Garro
authors.affiliation: Salvadorean Social Security Institute, San Salvador, El Salvador. dennisflores11@gmail.com.
authors.forename: Dennis
authors.initials: D
authors.lastname: Flores
authors.affiliation: SIIES research and education in health, Bogotá, Colombia. siiesconsultoressas@gmail.com.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sánchez
authors.affiliation: SIIES research and education in health, Bogotá, Colombia. siiesconsultoressas@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Castro
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000628:therapy*; D003191:Comprehensive Health Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000592:standards*; D019468:Disease Management; D006801:Humans; D012955:Societies, Medical
keywords: Centers of excellence; Competitiveness; Comprehensive patient care; Efficiency; Health care quality; Rheumatoid arthritis