Standards of care for inflammatory arthritis: A literature review

Quality standards are tools that may be used for advocacy, education, and for quality improvement purposes. The objective of this review is to describe the current landscape of quality standards for inflammatory arthritis (including rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritis), and to describe the methodology for standard development.

Three medical databases were reviewed, as well as major rheumatology and health care quality websites. Standards were abstracted and classified as pertaining to the structure, processes, or outcomes of health care and also thematically.

A total of 10 sets including over 300 standards were abstracted and classified into 29 themes, 62% related to processes and 38% to structure. While the standards encompassed many aspects along the continuum of patient care from early identification and access to multidisciplinary care, to patient treatment and education, there were no outcome standards. Furthermore, the methodology used to develop the standards was highly heterogeneous and patients were involved in only 50% of the development teams.

The review provides a comprehensive report on quality standards in inflammatory arthritis and highlights two uses of the term "Standard" in the quality literature as follows: (i) a numeric target for performance measurement and (ii) a statement about minimum, optimum, or aspirational goals of care that may not be easily measurable. Future standard development teams should include patients living with arthritis and should employ rigorous and transparent methodology for standard development and consider development of quality measures alongside standards to enhance uptake and impact of both tools.