Quality Care Assessment in Gout

Despite the availability of effective pharmacotherapy to lower serum urate (SUA) levels and consequently reduce the likelihood of flares, gout remains a poorly managed condition. Quality of care assessments are of paramount importance in evaluating the performance of health systems and providers in managing gout, spanning patient (micro), provider or team (meso), and organizational or system-wide (macro) levels. This review focuses on the conceptual underpinnings on how quality of care in gout management is defined and assessed, highlighting methodological challenges, study approaches and contemporary findings.

We illustrate the advantages and pitfalls on the use of quality indicators as the reference by which gout clinical care is deemed to be "optimal". We further introduce pertinent processes/intermediaries of gout care under a conceptual framework for quality assessment. Overall, quality of gout care requires significant improvement, with widespread deficiencies across key parameters including urate lowering therapy (ULT) adherence (micro-level), SUA monitoring (meso-level) and treatment to target SUA levels on a population basis (macro-level). There are large care gaps across processes, intermediaries and outcomes of gout care. Since accurate quality assessment forms the foundational pillar of subsequent quality improvement, this review serves as a reference to advance quality of gout care assessments. Further initiatives are required to enhance ULT adherence, in particular, which is a key intermediary step to optimal gout care and yet remains suboptimal on a population level. The integration of Learning Health Systems is emerging as a promising platform for improving the quality of gout care.