Development of system-level performance measures for evaluation of models of care for inflammatory arthritis in Canada

Claire E H Barber, Deborah A. Marshall, Dianne P. Mosher, Pooneh Akhavan, Lori Tucker, Kristin Houghton, Michelle Batthish, Deborah M. Levy, Heinrike Schmeling, Janet Ellsworth, Heidi Tibollo, Sean Grant, Dmitry Khodyakov, Diane Lacaille, Vandana Ahluwalia, Henry Averns, Cheryl Barnabe, Claire Bombardier, Susan J. Bartlett, Sasha BernatskyJennifer Burt, Debbie Feldman, Dafna D. Gladman, Beverly Greene, Boulos Haraoui, Nigil Haroon, Catherine Hofstetter, Adam M. Huber, Stephanie Keeling, Bianca Lang, Sharon A. Le Clercq, Theresa Lupton, Anne Lyddiatt, Rashmi Mandhane, Kimberly Morishita, Angelo Papachristos, Patricia Patrick, Dawn Richards, David Robinson, Natalie J. Shiff, Trudy Taylor, Regina Taylor-Gjevre, Glen T D Thomson, Carter Thorne, Karine Toupin-April, Peter Tugwell, Marie D. Westby, Jessica Widdifield, Linda Woodhouse, Michel Zummer

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)530-540
Number of pages11
JournalJournal of Rheumatology
Issue number3
StatePublished - Mar 1 2016
Externally publishedYes


  • Ankylosing spondylitis
  • Juvenile idiopathic arthritis
  • Psoriatic arthritis
  • Quality indicators
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy


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