Development of quality indicators to evaluate the monitoring of SLE patients in routine clinical practice

doi:10.1016/j.autrev.2010.12.008

Autoimmunity Reviews

Volume 10, Issue 7, May 2011, Pages 383-388

https://doi.org/10.1016/j.autrev.2010.12.008 Get rights and content

Abstract

The assessment of systemic lupus erythematosus (SLE) patients in routine clinical practice is mainly based on the experience of the treating physician. This carries the risk of unwanted variability. Variability may have an impact on the quality of care offered to SLE patients, thereby affecting outcomes. Recommendations represent systematically developed statements to help practitioners in reducing variability. However, major difficulties arise in the application of recommendations into clinical practice. In this respect, the use of quality indicators may raise the awareness among rheumatologists regarding potential deficiencies in services and improve the quality of health care.

The aim of this study was to develop a set of quality indicators (QI) for SLE by translating into QIs the recently developed EULAR Recommendations for monitoring SLE patients in routine clinical practice and observational studies.

Eleven QIs have been developed referring to the use of validated activity and damage indices in routine clinical practice, general evaluation of drug toxicity, evaluation of comorbidities, eye evaluation, laboratory assessment, evaluation of the presence of chronic viral infections, documentation of vaccination and of antibody testing at baseline. A disease specific set of quality assessment tools should help physicians deliver high quality of care across populations. Routine updates will be needed.

Highlights

► Variability in patients assessment may have an impact on the quality of care. ► Eleven quality indicators have been developed based on EULAR Recommendations. ► A disease specific set of quality indicators should help physicians deliver high quality of care. ► Routine updates will be needed.

Introduction

The assessment of SLE patients in routine clinical practice is affected by the experience of the treating physician. Differences in experience and training will lead to significant variability [1], [2]. Variability may have an impact on the quality of care offered to patients and ultimately influence outcomes. Recommendations represent systematically developed statements to support practitioners and patients to make decisions in specific clinical circumstances and essentially define best practice. Recommendations could help the physician in reducing variability of treatment approaches and pointing toward consensually developed therapeutic options. However, difficulties can arise in the application of recommendations into clinical practice, which may be explained largely by the gaps between recommendations and routine practice [3], [4], [5], [6].

Quality indicators (QI) represent the minimal standard of care that should be provided to patients and may represent a practical guide to physicians on steps to further improve the quality of care offered to patients [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. In addition, the translation of guidelines/recommendations into QIs could increase awareness of the existing guidelines and reduce the gap between guidelines and clinical practice. Their subsequent use to describe the minimal percentage of assessed patients at each center that would be considered a good compliance, still needs to be defined.

Recently a quality indicators set for SLE has been published, covering a number of aspects of patient's assessment [17]. The aim of this study was to develop a set of QIs for SLE by translating the recently developed EULAR Recommendations for monitoring SLE patients in routine clinical practice and observational studies [18] into QIs.

Section snippets

Methods

The procedure used to develop the QIs was based on the work done for the development of the EULAR recommendations. In brief, the following techniques were applied: nominal group, Delphi surveys for prioritisation, small group discussion, systematic literature review (SLR), and two rounds of Delphi technique for agreement [3], [18].

Subsequently, a preliminary list of QIs was developed, based on the EULAR Recommendations.

A Delphi survey was then carried between the panel of experts who had

Results

A preliminary set of 15 QIs was developed which included the following: use of validated activity and damage indices in daily practice; assessment of quality of life, drug toxicity and comorbidities in daily practice; screening for cervical intraepithelial neoplasm (CIN), breast cancer and colorectal cancer; ophthalmologic assessment in patients treated with hydroxychloroquine and glucocorticoids; patients monitoring, evaluation for the presence of chronic viral infections, documentation of

Discussion

The assessment of standard of care is increasingly relevant, as it represents a way to monitor whether appropriate care is given to patients. It could impact on patient treatment, as well as on appropriate allocation of health care resources. Assessing quality could improve patient outcomes, by promoting best practices among physicians [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17].

Quality indicators (QI) represent markers for compliance with minimal standards

Take-home messages

•
A patient assessment based on the experience of the treating physician carries the risk of unwanted variability.
•
Variability may have an impact on the quality of care.
•
Quality indicators (QIs) represent the minimal standard of care that should be provided to patients.
•
Quality indicators (QIs) represent the minimal standard of care that should be provided to patients.
•
The use of QIs to establish the numeric cut off that properly defines good clinical practice still needs to be discussed.

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View full text

ReviewDevelopment of quality indicators to evaluate the monitoring of SLE patients in routine clinical practice

Abstract

Highlights

Introduction

Section snippets

Methods

Results

Discussion

Take-home messages

Lancet

Soc Sci Med

Corticosteroid use in childhood-onset systemic lupus erythematosus—practice patterns at four pediatric rheumatology centers

Clin Exp Rheumatol

Health disparities in SLE

Curr Opin Rheumatol

EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committees

Ann Rheum Dis

EULAR efforts to define quality of care

Clin Exp Rheumatol

Osteoporosis screening, prevention, and treatment in systemic lupus erythematosus: application of the systemic lupus erythematosus quality indicators

Arthritis Care Res

Crossing the quality chasm: a new health system for the 21st century

Research methods used in developing and applying quality indicators in primary care

BMJ

Review
Development of quality indicators to evaluate the monitoring of SLE patients in routine clinical practice