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Review
. 2020 Mar 19;22(1):53.
doi: 10.1186/s13075-020-02151-w.

A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care

Claire E H Barber  1   2 , Marinka Twilt  3 , Tram Pham  2 , Gillian R Currie  2   3 , Susanne Benseler  3 , Rae S M Yeung  4   5 , Michelle Batthish  6 , Nicholas Blanchette  5   7 , Jaime Guzman  8 , Bianca Lang  9 , Claire LeBlanc  10 , Deborah M Levy  4   5 , Christine O'Brien  5 , Heinrike Schmeling  3 , Gordon Soon  5 , Lynn Spiegel  5 , Kristi Whitney  5 , Deborah A Marshall  11   12
Affiliations
Review

A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care

Claire E H Barber et al. Arthritis Res Ther. .

Abstract

Background: The evaluation of quality of care in juvenile idiopathic arthritis (JIA) is critical for advancing patient outcomes but is not currently part of routine care across all centers in Canada. The study objective is to review the current landscape of JIA quality measures and use expert panel consensus to define key performance indicators (KPIs) that are important and feasible to collect for routine monitoring in JIA care in Canada.

Methods: Thirty-seven candidate KPIs identified from a systematic review were reviewed for inclusion by a working group including 3 pediatric rheumatologists. A shortlist of 14 KPIs was then assessed using a 3-round modified Delphi panel based on the RAND/UCLA Appropriateness Method. Ten panelists across Canada participated based on their expertise in JIA, quality measurement, or lived experience as a parent of a child with JIA. During rounds 1 and 3, panelists rated each KPI on a 1-9 Likert scale on themes of importance, feasibility, and priority. In round 2, panelists participated in a moderated in-person discussion that resulted in minor modifications to some KPIs. KPIs with median scores of ≥ 7 on all 3 questions without disagreement were included in the framework.

Results: Ten KPIs met the criteria for inclusion after round 3. Five KPIs addressed patient assessments: pain, joint count, functional status, global assessment of disease activity, and the clinical Juvenile Arthritis Disease Activity Score (cJADAS). Three KPIs examined access to care: wait times for consultation, access to pediatric rheumatologists within 1 year of diagnosis, and frequency of clinical follow-up. Safety was addressed through KPIs on tuberculous screening and laboratory monitoring. KPIs examining functional status using the Childhood Health Assessment Questionnaire (CHAQ), quality of life, uveitis, and patient satisfaction were excluded due to concerns about feasibility of measurement.

Conclusions: The proposed KPIs build upon existing KPIs and address important processes of care that should be measured to improve the quality of JIA care. The feasibility of capturing these measures will be tested in various data sources including the Understanding Childhood Arthritis Network (UCAN) studies. Subsequent work should focus on development of meaningful outcome KPIs to drive JIA quality improvement in Canada and beyond.

Keywords: Juvenile idiopathic arthritis; Quality improvement; Quality indicators; Quality of care.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Summary of key performance indicators development process
Fig. 2
Fig. 2
Flow diagram of key performance indicators included in modified Delphi panel
See this image and copyright information in PMC

References

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    1. Bertilsson L, Andersson-Gare B, Fasth A, Petersson IF, Forsblad-D'elia H. Disease course, outcome, and predictors of outcome in a population-based juvenile chronic arthritis cohort followed for 17 years. J Rheumatol. 2013;40(5):715–724. doi: 10.3899/jrheum.120602. - DOI - PubMed
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