title: Nurse-led Care for Patients with Rheumatoid Arthritis: A Systematic Review of the Effect on Quality of Care.
abstract: In the nurse-led care (NLC) model, nurses take on the primary responsibility for patient management. We systematically assessed the effect of NLC for patients with rheumatoid arthritis (RA) on multiple dimensions of quality of care from the Alberta Quality of Care Matrix for Health.
  
  
  
  We searched MEDLINE, EMBASE, and CINAHL from 1950 to January 2015. English-language studies were included if they reported on NLC for patients with RA and assessed 1 or more dimensions of quality (effectiveness, acceptability, efficiency, accessibility, appropriateness, and safety). Data were synthesized using narrative analysis.
  
  
  
  We included 10 studies. The NLC models varied in terms of nurses' professional designation (clinical nurse specialists or nurse practitioners); however, their role in the clinic was fairly consistent. Disease activity was the most common measure of effectiveness, with NLC being equal (n = 2) or superior (n = 3) to the comparator. NLC was equal (n = 1) or superior (n = 5) versus the comparator in terms of patient satisfaction (i.e., acceptability of care). NLC was equally safe as other models (n = 2). Regarding efficiency, results varied across studies (n = 6) and did not allow for conclusions about models' cost-effectiveness. In qualitative studies, patients found NLC to be superior in terms of accessibility [i.e., continuity of care (n = 3) and appropriateness measured with education and support (n = 4)]; however, no quantitative measures were found.
  
  
  
  NLC for patients with RA is effective, acceptable, and safe as compared with other models. However, current evidence is insufficient to draw conclusions about its efficiency, accessibility, and appropriateness.
authors.affiliation: From the Department of Medicine, McMaster University, Hamilton, Ontario; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; Faculty of Nursing, University of Calgary; Department of Medicine, Cumming School of Medicine, University of Calgary; McCaig Institute for Bone and Joint Health; Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada.|S. Garner, MD, MSc, Department of Medicine, McMaster University; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; J.A. Rankin, NP, PhD, Faculty of Nursing, University of Calgary; D.A. Marshall, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Department of Medicine, Cumming School of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health, and Alberta Bone and Joint Health Institute.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Garner
authors.affiliation: From the Department of Medicine, McMaster University, Hamilton, Ontario; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; Faculty of Nursing, University of Calgary; Department of Medicine, Cumming School of Medicine, University of Calgary; McCaig Institute for Bone and Joint Health; Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada.|S. Garner, MD, MSc, Department of Medicine, McMaster University; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; J.A. Rankin, NP, PhD, Faculty of Nursing, University of Calgary; D.A. Marshall, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Department of Medicine, Cumming School of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health, and Alberta Bone and Joint Health Institute.
authors.forename: Elena
authors.initials: E
authors.lastname: Lopatina
authors.affiliation: From the Department of Medicine, McMaster University, Hamilton, Ontario; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; Faculty of Nursing, University of Calgary; Department of Medicine, Cumming School of Medicine, University of Calgary; McCaig Institute for Bone and Joint Health; Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada.|S. Garner, MD, MSc, Department of Medicine, McMaster University; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; J.A. Rankin, NP, PhD, Faculty of Nursing, University of Calgary; D.A. Marshall, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Department of Medicine, Cumming School of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health, and Alberta Bone and Joint Health Institute.
authors.forename: James A
authors.initials: JA
authors.lastname: Rankin
authors.affiliation: From the Department of Medicine, McMaster University, Hamilton, Ontario; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; Faculty of Nursing, University of Calgary; Department of Medicine, Cumming School of Medicine, University of Calgary; McCaig Institute for Bone and Joint Health; Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada. damarsha@ucalgary.ca.|S. Garner, MD, MSc, Department of Medicine, McMaster University; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; J.A. Rankin, NP, PhD, Faculty of Nursing, University of Calgary; D.A. Marshall, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Department of Medicine, Cumming School of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health, and Alberta Bone and Joint Health Institute. damarsha@ucalgary.ca.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Marshall
mesh_terms: D001172:Arthritis, Rheumatoid / Q000451:nursing*; D003362:Cost-Benefit Analysis; D006801:Humans; D017060:Patient Satisfaction; D011787:Quality of Health Care
keywords: ARTHRITIS; HEALTH SERVICES NEEDS AND DEMAND; RHEUMATOID ARTHRITIS