Quality Patient Care in Rheumatology a Challenge to Define, Measure

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Figure 1: Pneumococcal vaccination over time, before and after point-of-care reminder intervention. This shows the percentage of patients up to date with pneumococcal vaccination over time. The intervention was applied in two waves, with 10 physicians receiving the intervention in June 2010 and four additional physicians receiving the intervention in October 2010. In order to synchronize these data, time 0 was defined as the time that the intervention was applied to the patients of the treating rheumatologist. The red line represents the 21 rheumatologists in the control group and the blue line represents the 14 rheumatologists in the intervention group.

Source: Arthritis Rheum. 2013;65:39-47.

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Figure 2: Pneumococcal vaccination over time for 14 intervention rheumatologists. This shows a graph of the 14 intervention rheumatologists demonstrating the rate of patients up to date with pneumococcal vaccination.

Source: Arthritis Rheum. 2013;65:39-47.

Fitting the Patient into the Equation

How does the patient fit into the paradigm of quality of care? Patients have an evolving role in their disease management—particularly in many of the chronic diseases that we see, such as RA, systemic lupus erythematosus (SLE), and the vasculitides. With the increasing use of electronic health records that provide patient portals and the wide array of health information available on the Internet, many patients are able to access their own health information online and ask savvy questions about their diseases and their medications.

Engaging patients in their disease management can be an effective way to help improve patients’ satisfaction with their care. When patients understand the rationale for using more aggressive treatment strategies in RA and the real risks and benefits of the medications we prescribe, there may be a better adherence to the treatment plan, which can hopefully achieve better outcomes, such as low disease activity or remission.⁹ This experiment is being carried out in Sweden, where RA patient registries with web-based tools help patients track their own disease activity. It will be interesting to see whether they will play a role in changing the model of RA care delivery. Innovations such as smartphone applications, kiosks in the clinic, or computer tablets in the waiting room can help collect relevant data from our patients in a more efficient manner and enable us to make better decisions about disease management during the office visit.¹⁰ For example, integrating a disease activity tool into the electronic medical record provides rheumatologists with the ability to view important trends over time at the point of care.¹¹