Related Experiment Video
Updated: Mar 27, 2026
Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Development of System-level Performance Measures for Evaluation of Models of Care for Inflammatory Arthritis in
Claire E H Barber1, Deborah A Marshall1, Dianne P Mosher1
1From the Division of Rheumatology, Department of Medicine, and Section of Rheumatology, Department of Pediatrics, University of Calgary; Department of Community Health Sciences, Canada Research Chair in Health Systems, Calgary; Division of Pediatric Rheumatology, University of Alberta/Stollery Children's Hospital, Edmonton, Alberta; Division of Rheumatology, Department of Medicine, University of Toronto, Mount Sinai Hospital; Hospital for Sick Children, University of Toronto, Toronto; Division of Rheumatology, McMaster Children's Hospital, Department of Pediatrics, McMaster University, Hamilton, Ontario; Division of Rheumatology, Department of Pediatrics, University of British Columbia, BC Children's Hospital; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia, Canada; Doctor Evidence LLC; the RAND Corporation, Santa Monica, California, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary; D.A. Marshall, BSc, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Canada Research Chair in Health Systems, and Services Arthur JE Child Chair in Rheumatology Research, University of Calgary; D.P. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; P. Akhavan, MD, MSc, FRCPC, Division of Rheumatology, Department of Medicine, University of Toronto, Mount Sinai Hospital; L. Tucker, MD, FRCPC, Clinical Associate Professor, Division of Rheumatology, Department of Pediatrics, University of British Columbia; K. Houghton, MD, FRCPC, Clinical Associate Professor, Division of Rheumatology, Department of Pediatrics, University of British Columbia, BC Children's Hospital; M. Batthish, MSc, MD, FRCPC, Staff Physician, Division of Rheumatology, McMaster Children's Hospital, Assistant Professor, Department of Pediatrics, McMaster Univers
Objective:
To develop system-level performance measures for evaluating the care of patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis.
Methods:
This study involved several methodological phases. Over multiple rounds, various participants were asked to help define a set of candidate measurement themes. A systematic search was conducted of existing guidelines and measures. A set of 6 performance measures was defined and presented to 50 people, including patients with IA, rheumatologists, allied health professionals, and researchers using a 3-round, online, modified Delphi process. Participants rated the validity, feasibility, relevance, and likelihood of use of the measures. Measures with median ratings ≥ 7 for validity and relevance were included in the final set.
Results:
Six performance measures were developed evaluating the following aspects of care, with each measure being applied separately for each type of IA except where specified: waiting times for rheumatology consultation for patients with new onset IA, percentage of patients with IA seen by a rheumatologist, percentage of patients with IA seen in yearly followup by a rheumatologist, percentage of patients with RA treated with a disease-modifying antirheumatic drug (DMARD), time to DMARD therapy in RA, and number of rheumatologists per capita.
Conclusion:
The first set of system-level performance measures for IA care in Canada has been developed with broad input. The measures focus on timely access to care and initiation of appropriate treatment for patients with IA, and are likely to be of interest to other arthritis care systems internationally.
