Mary Bell (Sunnybrook Health Sciences Centre); Sicong Huang (University of Toronto); Joseph Moran (University of Toronto); Jenny Shu (University of Western Ontario); Raphael Rush (Queens University)
To assess adherence to Arthritis Foundation (AF) RA Quality Indicators (QIs) in university teaching hospital-based rheumatology clinics in Canada and to determine areas in need of education and safety improvement.
Retrospective chart audits for patients with RA under the care of a single rheumatologist for more than 1 year diagnosed January 2007-May 2010 were conducted in 4 Canadian centres. Participating clinics were: Sunnybrook Health Sciences Centre, Kingston General Hospital, Toronto Western Hospital, Mount Sinai Hospital. Descriptive statistics were performed for site adherence per chart audited and aggregate adherence for each QI. Site adherence was compared using one-way ANOVA.
74 charts were audited. Adherence differed significantly among sites (p<0.0001). QIs well adhered to (100%-83%) were: regular follow-up, radiographs of hands and feet, glucocorticoids, methotrexate transaminitis monitoring, DMARDs, folic acid, surgery, time to referral, baseline and follow-up studies, osteoporosis prophylaxis, assistive devices. QIs in need of improvement (75%-10%) were: reproductive issues, history and examination, radiographs of cervical spine, exercise, informing patient about risks, vaccines.
Adherence to 27 AFQIs requires improvement. Medication safety is well documented as is monitoring of medication side effects, mobility safety, needs assessment for assistive devices. Safety issues exist in the lack of cervical spine radiographs for patients undergoing general anaesthesia (posing risks of cervical subluxation) and in use of vaccines to prevent infectious diseases. Areas in need of improvement may inform practice-based performance improvement projects and provide needs analysis for designing multifaceted continuing education interventions. A reminder system is recommended to address these issues.