Development of a patient-centered quality measurement framework for measuring, monitoring, and optimizing rheumatoid arthritis care in Canada.

Objective To develop a patient-centered quality measurement framework to address a predefined vision statement and 7 strategic objectives for rheumatoid arthritis (RA) care, developed in prior qualitative work with arthritis stakeholders. Methods 147 RA-related performance measures (PMs) were identified from a systematic review. A candidate list of 26 PMs meeting pre-defined criteria and addressing the strategic objectives previously defined was then assessed during a 3-Round (R) Modified-Delphi. Seventeen panelists with expertise in RA, quality measurement and/or lived experience with RA rated each PM on a 1-9 scale based on the items of importance, feasibility and priority for inclusion in the framework during R1 and R3 with a moderated discussion in R2. PMs with median scores ≥7 on all 3 items without disagreement were included in the final set which then underwent public comment. Results 21 measures were included in the final framework (15 PMs from the Delphi and 6 published system-level measures on access to care and treatment). The measures included: 4 addressing early access to care and timely diagnosis, 12 evidence-based care for RA and related comorbidities, 1 addressing patient participation as an informed partner in care, and 4 on patient outcomes. Conclusion The proposed framework builds upon existing measures capturing early access to care and treatment in RA and adds important PMs to promote high quality RA care and outcome measurement. In the next phase, the authors will test the framework in clinical practice in addition to addressing certain areas where no suitable PMs were identified.