Development of American College of Rheumatology Quality Measures for Systemic Lupus Erythematosus: A Modified Delphi Process with RISE Registry Data Review

Details

• Alternative Title:
  Arthritis Care Res (Hoboken)
• Personal Author:
  Bartels, Christie M. ; Jorge, April ; Feldman, Candace H. ; Zell, JoAnn ; Bermas, Bonnie ; Barber, Claire E.H. ; Duarte-García, Alí ; Garg​, Shivani ; Haseley, Leah ; Jatwani, Shraddha ; Johansson, Tracy ; Limanni, Alex ; Rodgers, Wendy ; Rovin, Brad H. ; Casas, Yesenia Santiago ; Suter​, Lisa G. ; Barnado, April ; Ude, Jennifer ; Aguirre, Alfredo ; Li, Jing ; Schmajuk, Gabriela ; Yazdany, Jinoos
• Description:
  Objective
  
  We aimed to develop readily measurable digital quality measure statements for clinical care in systemic lupus erythematosus (SLE) using a multi-step process guided by consensus methods.
  
  Methods
  
  Using a modified Delphi process, an American College of Rheumatology (ACR) workgroup of SLE experts reviewed all North American and European guidelines from 2000–2020 on treatment, monitoring, and phenotyping of patients with lupus. Workgroup members extracted quality constructs from guidelines, rated these by importance and feasibility, and generated evidence-based quality measure statements. The ACR Rheumatology Informatics System for Effectiveness (RISE) registry was queried for measurement data availability. In three consecutive Delphi sessions, a multidisciplinary Delphi panel voted on importance and feasibility of each statement. Proposed measures with consensus on feasibility and importance were ranked to identify the top three measures.
  
  Results
  
  Review of guidelines and distillation of 57 quality constructs resulted in 15 quality measure statements. Among these, five met high consensus for importance and feasibility, including two on treatment and three laboratory monitoring measures. The three highest-ranked statements were recommended for further measure specification as SLE digital quality measures: 1) hydroxychloroquine use, 2) limiting glucocorticoid use >7.5 mg/day to <6 months, and 3) end-organ monitoring of kidney function and urine protein excretion at least every 6 months.
  
  Conclusion
  
  The Delphi process selected three quality measures for SLE care on hydroxychloroquine, glucocorticoid reduction and kidney monitoring. Next, measures will undergo specification and validity testing in RISE and US rheumatology practices as the foundation for national implementation and use in quality improvement programs.
  
  
• Subjects:
  Glucocorticoids Humans Hydroxychloroquine Lupus Erythematosus, Systemic Quality Indicators, Health Care Rheumatology Routinely Collected Health Data United States
• Source:
  Arthritis Care Res (Hoboken). 75(11):2295-2305
• Pubmed ID:
  37165898
• Pubmed Central ID:
  PMC10615706
• Document Type:
  Journal Article
• Funding:
  K24 AR074534/AR/NIAMS NIH HHSUnited States/ ; NU58DP006908/ImCDC/Intramural CDC HHSUnited States/ ; UL1 TR001863/TR/NCATS NIH HHSUnited States/ ; K23 AR079040/AR/NIAMS NIH HHSUnited States/ ; R01 AR080629/AR/NIAMS NIH HHSUnited States/ ; K23 AR071500/AR/NIAMS NIH HHSUnited States/ ; K08 AR072757/AR/NIAMS NIH HHSUnited States/ ; P30 AR070155/AR/NIAMS NIH HHSUnited States/ ; R01 HS028024/HS/AHRQ HHSUnited States/ ; NU58DP006908/CC/CDC HHSUnited States/
• Volume:
  75
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:d8817d71de9ec17c6586354658920a24bba0dc9697ec6ad8305e5fc0f493c7cba9f0f66862bff22d4a0bb71c39aca7622882b8f4a43cd75287e01203cf7948c4
• Download URL:
  https://stacks.cdc.gov/view/cdc/134765/cdc_134765_DS1.pdf
• File Type:
  [PDF - 1.42 MB ]