Asistance Quality Standards in Rheumatology

Alonso Ruiz, Alberto; Vidal Fuentes, Javier; Tornero Molina, Jesús; Carbonell Abelló, Jordi; y de Mercado, Pablo Lázaro; Dolores Aguilar Conesa, M.

doi:10.1016/S2173-5743(07)70252-6

Article information

Abstract

Bibliography

Download PDF

Statistics

Objective

To develop standards for quality of care and processing times in rheumatology.

Materials and methods

After a systematic review of the literature, a working group of 10 rheumatologists and 2 methodologists selected 164 indicators of quality of care and processing times. A panel of 65 experts rated the indicators following a Delphi methodology.

Results

Among the most important of the 164 standards obtained were: maximum number of inhabitants per rheumatologist (40 000-50 000); minimum number of rheumatologists in a Rheumatology Unit (3); duration of the first visit (30minutes) and successive visits (19minutes), ratio of successive/first visits (3.2); a rheumatologist should receive no more than 5 first visits/day and no more than 11 successive visits/day, and should spend no more than 5 hours on patients visits/day nor more than 4 days/week; the maximum waiting time for first visits should not exceed 4 weeks; the time needed to visit hospitalized patients (43minutes on admission, 17minutes for daily visit and 40minutes at discharge); and time to carry out some of the most frequent procedures in rheumatology (12minutes for arthrocentesis and infiltrations and 17minutes for synovial fluid analysis).

Conclusions

This study establishes basic standards for quality of care, organization and process times. It is a useful tool for organizing a rheumatology unit, which can facilitate dialogue with health administrators and help improve the quality of rheumatology care.

Key words:

Standards

Quality of care

Rheumatology

Objetivo

Elaborar estándares de calidad asistencial y de tiempos de los procesos reumatológicos.

Material y métodos

Tras una revisión sistemática de la literatura un grupo de trabajo, constituido por 10 reumatólogos y 2 metodólogos, ha seleccionado 164 indicadores de calidad y de tiempos de proceso. Un panel de 65 expertos los ha puntuado mediante metodología Delphi.

Resultados

Entre los 164 estándares obtenidos destacan: número máximo de habitantes por reumatólogo (40.000- 50.000); número mínimo de reumatólogos en una unidad de reumatología (3); tiempo de duración de la primera consulta (30min) y la sucesiva (19min), relación sucesiva/primera consulta (3,2); un reumatólogo no debe atender más de 5 primeras visitas/día y no más de 11 consultas sucesivas/día, no debe pasar consulta más de 5 h/día, ni más de 4 días/semana; el tiempo máximo de espera para la primera consulta no será superior a 4 semanas; el tiempo necesario para la visita de pacientes ingresados (43min al ingreso, 17min la visita diaria y 40min el alta); tiempo para la realización de las técnicas más frecuentes en reumatología (12min para artrocentesis e infiltraciones y 17min para análisis del líquido sinovial).

Conclusiones

Este estudio fija estándares básicos de calidad, organización y tiempo, y es un instrumento útil para la organización de una unidad de reumatología, ya que facilita el diálogo con los gestores sanitarios y contribuye a mejorar la calidad de la práctica reumatológica.

Palabras clave:

Estándares

Calidad asistencial

Reumatología

Full text is only aviable in PDF

References

[1.]

A. Alonso, J.L. Andreu, A. Bañares, J. Carbonell, F. Galdo, C. Isasi, et al.

Plan Estratégico de la Sociedad Española de Reumatología.

Rev Esp Reumatol, 26 (1999), pp. 347-354

[2.]

A. Alonso Ruiz, M. Calabozo Raluy, E. Martín Mola, P. Benito Ruiz, J. Carbonell Abelló.

Situación laboral de los reumatólogos formados en España entre 1990 y 1999.

Rev Esp Reumatol, 29 (2002), pp. 36-42

[3.]

L. Rodríguez Arboleya.

Los reumatológos en la asistencia pública española.

Rev Esp Reumatol, 24 (1997), pp. 295-301

[4.]

A. Alonso Ruiz, Concepto, et al.

clasificación de las enfermedades reumáticas.

Manual SER de las enfermedades reumáticas, 3. a ed,

[5.]

C.H. MacLean, K.G. Saag, D.H. Solomon, S.C. Morton, S. Sampsel, J.H. Klippel.

Measuring quality in arthritis care: methods for developing the Artritis Foundation's quality indicator set.

Arthritis Rheum, 51 (2004), pp. 193-202

http://dx.doi.org/10.1002/art.20248 | Medline

[6.]

K. Rowan, D. Doyle, I. Griffiths.

Standards of care for arthritis: pointing the way forward.

Br J Rheumatol, 37 (1998), pp. 242-245

Medline

[7.]

Panel de expertos recomendados por la Sociedad de Reumatología de la Comunidad de Madrid (SORCOM).

Criterios de calidad para la asistencia reumatológica.

Rev Esp Reumatol, 29 (2002), pp. 155-157

[8.]

C.E. Jacobi, H.C. Boshuizen, I. Rupp, H.J. Dinant, G.A. van den Bos.

Quality of rheumatoid arthritis care: the patient's perspective.

Int J Qual Health Care, 16 (2004), pp. 73-81

http://dx.doi.org/10.1093/intqhc/mzh009 | Medline

[9.]

T.R. Mikuls, C.H. MacLean, J.T. Farrar, W.B. Bilker, K.G. Saag.

Quality of Care Indicators for Gout Management.

Arthritis Rheum, 50 (2004), pp. 937-943

http://dx.doi.org/10.1002/art.20102 | Medline

[10.]

K.G. Saag, J.J. Olivieri, F. Patino, T.R. Mikuls, J.J. Allison, C.H. MacLean.

Measuring quality in arthritis care: the Artritis Foundation's quality indicator set for analgesics.

Arthritis Rheum, 51 (2004), pp. 337-349

http://dx.doi.org/10.1002/art.20422 | Medline

[11.]

J.N. Pencharz, C.H. MacLean.

Measuring quality in arthritis care: the Arthritis Foundation's Quality indicator set for Osteoarthritis.

Arthritis Rheum, 51 (2004), pp. 538-548

http://dx.doi.org/10.1002/art.20521 | Medline

[12.]

A.N. Bamji.

Waiting times referrals.

Rheumatology, 39 (2000), pp. 349-352

Medline

[13.]

C. van Campen, H.J. Sixma, J.J. Kerssens, L. Peters, J.J. Rasker.

Assessing patients’ priorities and perceptions of the quality of health care: the development of the QUOTE-Rheumatic-Patients instrument.

Rheumatology, 37 (1998), pp. 362-368

[14.]

J. Hetthen, P.S. Helliwell.

A comparison between primary care-led rheumatology services and secondary care provision.

Rheumatology, 38 (1999), pp. 1294-1295

Medline

[15.]

P.S. Helliwell, J. Hetthen.

Primary care rheumatology-leading the way?.

Rheumatology, 38 (1999), pp. 1174-1176

Medline

[16.]

D.L. Scott, M. Shipley, A. Dawson, S. Edwards, D.P. Symmons, A.D. Woolf.

The clinical management of rheumatoid arthritis and osteoarthritis: strategies for improving clinical effectiveness.

Rheumatology, 37 (1998), pp. 546-554

[17.]

H.S. Miedema, S.M. van der Linden, J.J. Rasker, H.A. Valkenburg.

National database of patients visiting rheumatologists in the Netherlands: the standard diagnosis register of rheumatic diseases. A report and preliminary análisis.

Rheumatology, 37 (1998), pp. 555-561

[18.]

M.P. Aguado Acín, E. Martín Mola.

Gestión clínica y calidad en reumatología.

Rev Esp Reumatol, 30 (2003), pp. 448-455

[19.]

The British Society for Rheumatology. Guideline on Standards of care for persons with Rheumatoid Arthritis. London, July 2004.

[20.]

The British League Against Rheumatism. Standards of Care for Osteoarthritis (OA) and Rheumatoid Arthritis (RA) [cited on July 26, 2004]. Available from: https://www.msecportal.org

[21.]

The Royal College of Physicians of London Committee on Rheumatology. The British Society for Rheumatology. Musculoskeletal disorders: providing for the patients needs 3. A basis for planning a Rheumatology Service [cited on July 26, 2004]. Available from: https://www.msecportal.org

[22.]

Sampel S, MacLean C, Renner P, Mardon R. Measuring Quality of Care in People with Artritis. National Committee for Quality Assurance (NCQA) [cited on July 28, 2004]. Available from: http://www.ncqa.org

[23.]

E.A. McGlynn, K.A. Clark.

Low back pain (acute).Chapter 15.

Quality of care for General Medical conditions: a review of the literature and quality indicators, pp. 207-224

[24.]

J. Ma Quintana, A. Escobar, A. Bilbao, IRYSS-Appropriateness Cataract Group.

Explicit criteria for prioritization of cataract surgery.

BMC Health Serv Res, 6 (2006), pp. 24

http://dx.doi.org/10.1186/1472-6963-6-24 | Medline

[25.]

F. Asencio, J. Aguiló, A. Arroyo, A. Baltasar, J. Camacho, A. Compañ, et al.

Estudio Delphi de la Sociedad Valenciana de Cirugía: tratamiento quirúrgico del cáncer gástrico.

Cir Esp, 67 (2000), pp. 276-280

[26.]

M.D. Aguilar, K. Fitch, P. Lázaro, S.J. Berstein.

The appropriateness of use of percutaneous transluminal coronary angioplasty in Spain.

Int J cardiol, 78 (2001), pp. 213-221

Medline

[27.]

J.I. Rodríguez.

Propuesta de estándar asistencial en la reparación de la hernia inguinal o crural.

Cir Esp, 73 (2003), pp. 331-335

[28.]

K. Fitch, S.J. Berstein, M.D. Aguilar, B. Burnand, J.R. LaCalle, P. Lázaro, et al.

The RAND/UCLA Appropriateness Method User's Manual.

RAND, (2001),

[29.]

S.J. Bernstein, P. Lázaro, K. Fitch, M.D. Aguilar, H. Rigter, J.P. Kahan.

Appropriateness of coronary revascularization for patients with chronic stable angina or following an acute myocardial infarction: multinational versus Dutch criteria.

Int J Quality in Health Care, 14 (2002), pp. 103-109

[30.]

W.D. Marder, R.F. Menean, D.T. Felson, M. Reichlin, N.S. Bimbaum, J.D. Croft, et al.

The presentand future adequacy of rheumatoloy manpower. A stady of health care needs and physician supply.

Arthritis Rheum, 34 (1991), pp. 1209-1217

Medline

Indexed in:

Follow us:

Subscribe:

Indexed in:

Follow us:

Subscribe:

Subscribe to our newsletter