title: Quality standards for rheumatology outpatient clinic. The EXTRELLA project.
abstract: BACKGROUND
  In recent years, outpatient clinics have undergone extensive development. At present, patients with rheumatic diseases are mainly assisted in this area. However, the quality standards of care are poorly documented.
  
  
  OBJECTIVE
  To develop specific quality criteria and standards for an outpatient rheumatology clinic.
  
  
  METHODS
  The project was based on the two-round Delphi method. The following groups of participants took part: scientific committee (13 rheumatologists), five nominal groups (45 rheumatologists and 12 nurses) and a group of discussion formed by 9 patients. Different drafts were consecutively generated until a final document was obtained that included the standards that received a punctuation equal or over 7 in at least 70% of the participants.
  
  
  RESULTS
  148 standards were developed, grouped into the following 9 dimensions: a) structure (22), b) clinical activity and relationship with the patients (34), c) planning (7), d) levels of priority (5), e) relations with primary care physicians, with Emergency Department and with other clinical departments, f) process (26), g) nursing (13), h) teaching and research (13) and i) activity measures (8).
  
  
  CONCLUSIONS
  This study established specific quality standards for rheumatology outpatient clinic. It can be a useful tool for organising this area in the Rheumatology Department and as a reference when proposing improvement measures to health administrators.
authors.affiliation: Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. Electronic address: jmnolla@ub.edu.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Nolla
authors.affiliation: Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Martínez
authors.affiliation: Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España.
authors.forename: Rosario
authors.initials: R
authors.lastname: García-Vicuña
authors.affiliation: Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seoane-Mato
authors.affiliation: Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España.
authors.forename: M Piedad
authors.initials: MP
authors.lastname: Rosario Lozano
authors.affiliation: Servicio de Reumatología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Alperi
authors.affiliation: Servicio de Reumatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España.
authors.forename: Ceferino
authors.initials: C
authors.lastname: Barbazán
authors.affiliation: Servicio de Reumatología, Hospital Sierrallana, Torrelavega, Cantabria, España.
authors.forename: Jaime
authors.initials: J
authors.lastname: Calvo
authors.affiliation: Servicio de Reumatología, Hospital Clínco Universitario Lozano Blesa, Zaragoza, España.
authors.forename: Concepción
authors.initials: C
authors.lastname: Delgado
authors.affiliation: Servicio de Reumatología, Hospital Regional Universitario de Málaga, IBIMA, Málaga, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Nebro
authors.affiliation: Servicio de Reumatología, Hospital Universitari Germans Trías i Pujol, Badalona, Barcelona, España.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Mateo
authors.affiliation: Servicio de Reumatología, Complejo Asistencial Universitario de León, León, España.
authors.forename: Trinidad
authors.initials: T
authors.lastname: Pérez Sandoval
authors.affiliation: Servicio de Reumatología, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, España.
authors.forename: José
authors.initials: J
authors.lastname: Pérez Venegas
authors.affiliation: Servicio de Reumatología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez Lozano
authors.affiliation: Servicio de Reumatología, Hospital de la Marina Baixa, Villajoyosa, Alicante, España.
authors.forename: José
authors.initials: J
authors.lastname: Rosas
mesh_terms: D000554:Ambulatory Care Facilities / Q000592:standards*; D003697:Delphi Technique; D006801:Humans; D011787:Quality of Health Care / Q000592:standards*; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000628:therapy; D012219:Rheumatology / Q000592:standards*; D013030:Spain
keywords: Calidad asistencial; Consultas externas; Outpatient clinic; Quality of care; Reumatología; Rheumatology