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          0 => array:3 [
            "entidad" => "Unidad de Investigaci&#243;n&#44; Sociedad Espa&#241;ola de Reumatolog&#237;a&#44; Madrid&#44; Spain"
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            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Universitario Puerta de Hierro&#44; Majadahonda&#44; Madrid&#44; Spain"
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            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital de Sant Joan Desp&#237; Mois&#232;s Broggi&#44; Consorci Sanitari Integral&#44; Sant Joan Desp&#237;&#44; Barcelona&#44; Spain"
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            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital General de Jerez de la Frontera&#44; Jerez de la Frontera&#44; C&#225;diz&#44; Spain"
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            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Universitario Marqu&#233;s de Valdecilla&#44; Santander&#44; Cantabria&#44; Spain"
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            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital General de M&#233;rida&#44; M&#233;rida&#44; Badajoz&#44; Spain"
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            "entidad" => "Servicio de Reumatolog&#237;a&#44; Fundaci&#243;n Hospital Alcorc&#243;n&#44; Alcorc&#243;n&#44; Madrid&#44; Spain"
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    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Indicador compuesto para evaluar la calidad asistencial en el manejo de los pacientes con artritis reumatoide en las consultas externas de Reumatolog&#237;a"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The strategic objectives of the Spanish Rheumatology Society include promoting care quality in daily clinical practice&#44; establishing quality criteria and standards for the care of patients with rheumatological diseases and ensuring their follow-up&#44; updating and monitoring&#44; thus completing a cyclical process of continuous quality improvement&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Among the wide range of rheumatic diseases&#44; rheumatoid arthritis &#40;RA&#41; has undergone a revolution over recent decades because of the major importance of early diagnosis and prompt treatment with disease-modifying drugs &#40;DMDs&#41;&#44; which are essential to control the activity of the disease in the medium and long term&#44; and modify its prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#8211;4</span></a> Other factors that have contributed to this therapeutic paradigm shift are a stricter and more precise evaluation of the activity of the disease&#44; the application of the recommendations for the appropriate use of methotrexate &#40;MTX&#41; in combination with folic or folinic acid&#44; recognised as a potent drug for controlling the disease&#44; and from the year 2000&#44; the introduction of biological therapy&#46; This new knowledge has become consolidated over recent years&#44; and in 2010 a set of international recommendations were published for the strict control of the treatment of RA in daily clinical practice&#44; known as &#8220;treat to target&#8221; &#40;T2T&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> These were updated in 2016&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> setting out as key pillars for the clinical management of these patients the definition of treating to target&#44; understood as periodically evaluating the inflammatory activity by composite activity indices until remission or low inflammation activity is achieved&#44; as well as a dynamic interrelationship between the empowered patient and the rheumatologist&#44; where therapeutic adjustments are made at each visit as the targets set are achieved&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">All of the above&#44; along with the implementation of general recommendations on the clinical care of RA patients&#44; will contribute towards improving the quality of care for these patients&#46; It is in this context that the ARExcellence &#40;<span class="elsevierStyleItalic">assessment of the care quality in the clinical management of patients with RA in rheumatology outpatient clinics</span>&#41; project was born&#44; which uses a composite indicator &#40;CI&#41; methodology to develop a standardised process of evaluation and monitoring of care quality including criteria from the T2T strategy&#44; from general recommendations on prevention and health promotion measures &#40;healthy life habits&#44; immunisation and control of cardiovascular risk&#41;&#44; from the pharmacological management of conventional DMDs and glucocorticoids&#44; and from the organisation of rheumatology units &#40;RU&#41;&#46; The aim of this paper was to construct a CI&#44; as a summary measure of care quality in the clinical management of RA patients attended in the rheumatology departments of Spanish hospitals&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Group of Experts</span><p id="par0020" class="elsevierStylePara elsevierViewall">In order to construct the CI a group of experts was formed that comprised the principal investigator &#40;PI&#41;&#44; the scientific committee &#40;SC&#41; of the ARExcellence&#44; and 16 panellists&#46; The SC comprised 3 rheumatologists&#44; 2 of them heads of care level 5 hospital departments &#40;very large hospitals&#44; of great structural weight and a lot of care activity&#59; over 900 beds&#59; very technologically advanced and with a complex service portfolio&#41;&#44; with wide experience in the clinical management of patients with RA&#44; in care quality and epidemiological research&#46; The third member of the project&#39;s SC and the PI are attending rheumatologists from level 5 hospitals&#44; who also have wide experience in the clinical management of patients with RA&#44; in care quality and epidemiological research&#46; The 16 panel members were chosen based on their experience in the clinical management of patients with RA and their knowledge of quality of care&#46; Efforts were made to ensure that most of the autonomous regions were represented by at least one rheumatologist&#44; and the panellists were selected based on sex&#44; age&#44; professional category and the care level of their hospital&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The entire process of constructing the CI was coordinated by a female epidemiologist with training and experience in the methodology for evaluating quality of care and CI design&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Process for Constructing the Composite Indicator</span><p id="par0030" class="elsevierStylePara elsevierViewall">The following stages were followed to construct the CI&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Definition of the phenomenon to be assessed&#46; The PI and the SC defined&#44; through formal expert judgement&#44; the phenomenon to be evaluated as care quality for patients with RA&#46; Formal expert judgement is the informed opinion of people with a track record in the subject&#44; who are recognised by others as qualified experts in the subject&#44; and who can provide information&#44; evidence&#44; judgements and evaluations&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Selection of criteria of quality&#44; definition of their indicators and formulae&#46; In an initial phase&#44; the PI and the SC selected a set of 37 criteria of quality&#44; from a review of the scientific literature&#44; which focussed on the recommendations of the T2T strategy and on the clinical management of RA patients &#40;preventive and health promotion measures&#44; therapeutic management with DMDs and glucocorticoids&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the 37 criteria of quality that were selected&#59; 35 of which are of process&#44; and 2 of structure&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Prioritisation of the criteria of quality&#46; The prioritisation of the quality criteria were agreed using the Delphi methodology&#58; a systematic&#44; interactive and group process aimed at collecting opinions and consensus on the relevance and feasibility of the criteria of quality&#44; based on the experience and subjective judgement of experts&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> The panel who took part in the Delphi methodology comprised the aforementioned group of experts&#44; who agreed the grade of agreement on the clinical relevance and the feasibility of collecting data in the medical history of the evaluated criteria of quality&#44; as well as offering suggestions or changes to the drafting of the criteria based on an open question included in the surveys&#46; This enabled the criteria of quality to be included&#44; removed or adjusted as proposed by the PI and the SC of the project&#46;</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">The Delphi methodology was carried out in 2 rounds by prior decision&#46; Before the first round&#44; each of the panellists was contacted to invite them to participate and give their consent&#46; After they had accepted&#44; they were each sent the first round questionnaire by email&#44; and instructions on how to complete it&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">First round questionnaire&#46;</span> This questionnaire contained 37 criteria of quality <span class="elsevierStyleItalic">&#40;see supplementary material&#41;</span>&#44; organised in 2 blocks&#44; according to the dimensions of quality &#40;accessibility and scientific and technical appropriateness&#41; and the nature of the criterion &#40;structure and process&#41;&#58; block A&#58; accessibility criteria &#40;3 criteria&#41;&#44; block <span class="elsevierStyleItalic">B</span>&#58; scientific and technical appropriateness criteria &#40;32 criteria&#41;&#44; and block C&#58; structure criteria &#40;2 criteria&#41;&#46; Each criterion was assessed according to its relevance and feasibility&#44; using a visual numerical scale from 0 to 10&#44; to measure the grade of agreement with each statement&#46; A score &#8220;0&#8221; indicted complete disagreement and a score &#8220;10&#8221; indicated complete agreement with the statement&#46; Relevance was defined as the clinical importance of the criterion&#44; understood as the impact on health outcomes&#44; and feasibility as the availability of resources to evaluate the criterion of quality&#44; i&#46;e&#46;&#44; if the information to assess the quality was available in the patients&#8217; medical history&#44; this is the source of information used to develop quality of care&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">For each of the criteria of quality to be agreed the panellist was requested to justify their response from comments based on their professional experience or scientific evidence-based information&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Second round questionnaire&#46;</span> The second round questionnaire comprised 12 criteria and followed the same structure as the first &#40;see supplementary material&#41;&#46; The panellist&#39;s individual assessment was added to each criterion and the score awarded in the first round by the group of experts&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A qualitative and quantitative analysis was performed of both rounds&#46; The quantitative analysis consisted of calculating the median&#44; as a measure of central tendency&#44; and the interquartile range&#44; as a measure of dispersion&#46; In addition&#44; the percentage of responses was calculated with a score equal or above 7&#46;5 for relevance or feasibility&#44; for each criterion of quality&#46; Agreement was defined when a median value equal or above 7 was achieved from more than 80&#37; of the panellists&#46; The qualitative phase of the first round consisted of analysing the comments on the criteria made by the panellists&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The analysis of the second round was performed following the same methodology and the same criteria as that used to establish agreement in the first round&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Based on the prioritised criteria of quality&#44; the quality indicators and their formulae were defined following the methodology for the design and creation of the indicators &#40;see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Construction of the CI&#46; The sum of the values obtained for each indicator was used as the aggregation method for constructing the CI&#44; this is a simple method widely used in the area of health&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#44;10</span></a> The indicators were measured in the form of simple percentages&#44; and the average of the medians of the relevance and feasibility assessments awarded by the panel of experts in the Delphi methodology were used as the weight factor&#46;</p></li></ul></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">Of the 37 criteria selected&#44; 12 passed through to the second Delphi round&#46; After the analysis of this round&#44; the prioritised quality indicators and&#44; therefore&#44; forming part of the CI&#44; totalled 31&#46; The results of the first and second Delphi rounds are shown in <a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The formula for calculating the weighted CI &#40;WCI&#41; was&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">&#40;Ind</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>indicator&#41;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study enabled the construction of a CI that offers a synthetic measure of the quality of care for patients with RA in the RU of Spanish hospitals&#44; and a way of monitoring so that a check can be made that patients are being attended within the pre-established ranges defining quality of care&#44; and that any problems that require action can be identified&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The use of this type of indicator that summarises the measurement of various aspects of the same problem in a single number&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> is widely known in socioeconomic<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13&#44;14</span></a> and health<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;16</span></a> environments&#46; In the field of rheumatology&#44; these indicators are also used a great deal as synthetic measures&#44; essentially to evaluate clinical factors&#44; such as the inflammatory activity of many diseases &#40;DAS28&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> BASDAI<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> and CDAI<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a>&#41;&#44; and are an essential pillar in their management and control&#46; In contrast&#44; there is far less experience in the use of these CI to evaluate more general concepts&#44; such as quality of care in rheumatology&#46; A strength of this paper is that it provides the construction of an indicator that enables an assessment of the scientific and technological appropriateness deriving from the T2T strategy &#40;evaluation of inflammatory activity and pharmacological guidance to achieve the therapeutic target&#41;&#44; general recommendations on healthy life habits&#44; preventative measures&#44; pharmacological management with traditional DMDs and glucocorticoids for the control of RA&#44; and organisational factors of the units&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Some of the advantages of using these indicators is that&#44; as they provide an overall view of the quality of care&#44; which makes them more interpretable than the individual assessment of a set of indictors&#44; they are of great interest for the public in general&#44; and provide a measure that enable comparisons with other units&#44; such as for example other healthcare systems&#44; clinical services or countries &#40;European Union Consultative meeting held in Brussels in 2002<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a>&#41;&#46; Another aspect in favour of the constructed CI is not reconverting the indicator scales &#40;29 of the 31 indicators that comprise the CI use the same measurement system&#41;&#44; which also makes this an easily interpretable CI&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Although they have major strengths&#44; it is worth mentioning that these indicators also have some weaknesses&#44; essentially arising from the methodology used for their construction&#58; the selection of the indicators&#44; the grouping methodology or the need for a great amount of data for their construction&#44; since all the component indicators have to be measured&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> This&#44; although still relevant since it would affect the validity of the indicator&#44; is considered a methodological challenge to resolve more than a real disadvantage that would limit their use&#46; In this regard&#44; in this paper the construction of the CI followed a rigorous methodology so as not to affect its internal validity&#44; and for it to be easily interpretable&#46; The selections of quality criteria were based on the scientific literature and on the clinical experience of rheumatologists with a wide knowledge of the management of patients with RA&#46; Just as efforts were made to achieve the representativeness of the panellists who took part in the selection and the prioritisation of the criteria in terms of sociodemographic features&#44; years of care activity&#44; professional category and the care level of their centre&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A limit that is worthy of mention is the aggregation method used to construct the CI&#46; Using the sum made it simple to apply and interpret&#44; although as occurs with other CI that use this method &#40;Top 20 Classification of Spain&#39;s hospitals&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> the mean values can mask situations of very low indicators which are compensated by others that are higher&#46; Another limitation to flag up with these CI is that&#44; although all the indicators that construct them are measurable&#44; some of them could be over-represented&#44; because other indicators have been under-recorded due to a lack of information in the medical history&#46; Nevertheless&#44; this is not expected to be particularly relevant in the CI of this study&#44; since&#44; in the criteria prioritisation phase&#44; the group of experts explored the feasibility of evaluating the indicators using a two-round Delphi&#44; taking into account that there was enough information in the medical histories&#46; Those which the experts considered&#44; by consensus&#44; were not feasible to evaluate because there was a high probability of a lack of information in the medical histories did not go on to form part of the final list of criteria to be assessed&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Regarding the weighting&#44; we should mention that despite having constructed the CI as a weighted index&#44; in practice it behaved like an unweighted index&#44; since there was hardly any variability in the magnitude of the weighting factor of the indicators&#44; and they were considered not to be discriminating in relevance and feasibility&#46; The weighting method used&#44; the agreement in expert judgement&#44; although accepted for its validity and widely used to weight indicators by other international organisations&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">16&#44;20</span></a> requires further studies that use different weighting methods with a view to confirming these findings&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">From a clinical and care perspective&#44; the availability of this indicator and its individual components will enable areas for improvement to be identified in the care process of a disease such as RA&#44; where it is widely accepted that speedy diagnosis and treatment with disease-modifying drugs&#44; dynamic treatment adjustment and the goal of remission or&#44; at least low disease activity&#44; result in reduced structural damage and functional limitation for patients&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study presents the development of a CI of care quality for RA patients&#44; providing an objective and agreed tool for overall assessment of the care process&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical Diclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of people and animals</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Data confidentiality</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financing</span><p id="par0160" class="elsevierStylePara elsevierViewall">The project promoter is the Spanish Rheumatology Foundation with funds awarded by Abbvie to finance the ARExcellence Project&#46; The company did not participate in the design of the Project or intervene in the conclusions or the drawing up of the final report or this manuscript&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of Interests</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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          "identificador" => "xpalclavsec1104686"
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          "titulo" => "Introduction"
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        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and Methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Group of Experts"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Process for Constructing the Composite Indicator"
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          "identificador" => "sec0025"
          "titulo" => "Results"
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          "identificador" => "sec0030"
          "titulo" => "Discussion"
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          "titulo" => "Ethical Diclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Protection of people and animals"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Data confidentiality"
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            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
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        9 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Financing"
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        10 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflict of Interests"
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        11 => array:1 [
          "titulo" => "References"
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      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-12-20"
    "fechaAceptado" => "2017-06-02"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1104685"
          "palabras" => array:5 [
            0 => "Rheumatoid arthritis"
            1 => "Health care quality assessment"
            2 => "Treat to target"
            3 => "Composite indicator"
            4 => "Health care quality indicators"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1104686"
          "palabras" => array:5 [
            0 => "Artritis reumatoide"
            1 => "Evaluaci&#243;n de la calidad asistencial"
            2 => "Tratamiento por objetivos"
            3 => "Indicador compuesto"
            4 => "Indicadores de calidad en cuidados de salud"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The current guidelines in the treatment of rheumatoid arthritis &#40;RA&#41; include the early diagnosis and early use of disease modifying drugs to achieve remission or low disease activity level&#44; known as &#8220;Treat to Target&#8221; &#40;T2T&#41;&#46; The objective of this study is to develop a composite indicator &#40;CI&#41; to evaluate the quality of care in the management of patients with RA&#44; according to the T2T strategy and other general recommendations concerning the management of these patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The phases of the construction of the CI were&#58; &#40;1&#41; selection of quality criteria through expert judgement&#59; &#40;2&#41; prioritisation of the criteria&#44; according to relevance and feasibility&#44; applying the Delphi methodology &#40;two rounds&#41; involving 20 experts&#59; &#40;3&#41; design of quality indicators&#59; and &#40;4&#41; calculation of the weighted CI&#44; using the mean value in relevance and feasibility granted by the experts&#46; The source of information for the calculation of the CI are the medical records of patients with RA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Twelve criteria out of 37 required a second Delphi round&#46; Thirty-one criteria were prioritised&#46; These criteria presented a median in relevance and feasibility greater than or equal to 7&#46;5&#44; with an interquartile range of less than 3&#46;5&#44; and a level of agreement &#40;score greater than or equal to 8&#41; greater than or equal to 80&#37;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The constructed CI allows us to evaluate the quality of care of patients with RA following the T2T strategy in the rheumatology units of Spanish hospitals&#44; offering a valid and easily interpretable summary measure&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and method"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El paradigma actual en el tratamiento de la artritis reumatoide &#40;AR&#41; contempla el diagn&#243;stico temprano y el uso precoz de f&#225;rmacos modificadores de enfermedad &#40;FAME&#41; para alcanzar la remisi&#243;n o baja actividad inflamatoria&#44; lo cual&#44; se conoce como &#171;treat to target&#187; &#40;T2T&#41;&#46; El objetivo del trabajo es desarrollar un indicador compuesto &#40;IC&#41; para evaluar la calidad asistencial en el manejo de los pacientes con AR atendiendo a la estrategia T2T y a otras recomendaciones generales para la atenci&#243;n de estos pacientes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La construcci&#243;n del IC sigui&#243; las fases&#58; <span class="elsevierStyleItalic">1&#41;</span> selecci&#243;n de los criterios de calidad mediante un juicio de expertos&#59; <span class="elsevierStyleItalic">2&#41;</span> priorizaci&#243;n de los criterios&#44; a partir de un Delphi con 20 expertos&#59; <span class="elsevierStyleItalic">3&#41;</span> dise&#241;o de los indicadores de calidad&#44; y <span class="elsevierStyleItalic">4&#41;</span> c&#225;lculo del IC ponderado&#46; La fuente de informaci&#243;n para el c&#225;lculo del IC son las historias cl&#237;nicas de los pacientes con AR&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 37 criterios seleccionados&#44; 12 necesitaron una segunda ronda Delphi&#46; Se priorizaron 31 criterios&#44; los cuales presentaron una mediana en relevancia y factibilidad&#44; en las rondas Delphi&#44; mayor o igual a 7&#44;5&#44; con un rango intercuart&#237;lico inferior a 3&#44;5&#44; y un grado de acuerdo &#40;puntuaci&#243;n mayor o igual a 8&#41; igual o superior al 80&#37;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El IC construido&#44; consensuado y ponderado&#44; permite evaluar la calidad asistencial de los pacientes con AR&#44; en las Unidades de Reumatolog&#237;a de hospitales espa&#241;oles&#44; ofreciendo una medida resumen v&#225;lida y f&#225;cilmente interpretable&#46;</p></span>"
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            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todo"
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            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Mart&#237;n-Mart&#237;nez MA&#44; Andreu-Sanchez JL&#44; Sanchez-Alonso F&#44; Corominas H&#44; Perez-Venegas JJ&#44; Roman-Ivorra JA&#44; et al&#46; Indicador compuesto para evaluar la calidad asistencial en el manejo de los pacientes con artritis reumatoide en las consultas externas de Reumatolog&#237;a&#46; Reumatol Clin&#46; 2019&#59;15&#58;156&#8211;164&#46;</p>"
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            "apendice" => "<p id="par0175" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary Data"
            "identificador" => "sec0070"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">RA&#58; rheumatoid arthritis&#59; CDAI&#58; Clinical Disease Activity Index&#59; DAS28&#58; Disease Activity Score&#59; VAS&#58; visual analogue scale&#59; DMD&#58; disease-modifying drug&#59; MTX&#58; methotrexate&#59; PPD&#58; purified protein derivative&#59; SDAI&#58; Simple Disease Activity Index&#59; HBV&#58; hepatitis B virus&#59; HCV&#58; hepatitis C virus C&#59; HIV&#58; human immunodeficiency virus&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; The interval between requesting a rheumatology consultation and the first visit to the rheumatologist was less than 4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; The interval between the first rheumatology visit and establishing a diagnosis of RA was less than 2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; The interval between the first visit to rheumatology and starting MTX or the first conventional DMD was less than 2 weeks&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; It is recorded in the medical history that the patient was advised to stop smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; It is recorded in the medical history that the patient was advised to achieve and maintain an appropriate weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; It is recorded in the medical history that the patient was advised to maintain good oral health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; It is recorded in the medical history that an explicit assessment was made of factors of poor prognosis as a determining element in the choice of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; It is recorded in the medical history that an explicit evaluation of activity was made as a determining element in the choice of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; A chest X-ray was performed before MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; Folic acid was prescribed if MTX was prescribed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46; Low doses of glucocorticoids and DMDs were prescribed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#46; Glucocorticoids have were not prescribed in doses above 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day of prednisone or the equivalent for periods longer than one month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&#46; It is recorded in the medical history that injections were prescribed for inflamed joints as part of good systemic control of the disease&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&#46; It is recorded in the medical history that the dose of MTX was increased to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;week before deciding an inadequate response to MTX&#44; in the absence of adverse effects that made it necessary to discontinue MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#46; The MTX administration route was recorded&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&#46; It is recorded in the medical history that the patient was monitored every month until remission or low disease activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&#46; It is recorded in the medical history that activity indices were used at visits &#40;DAS28&#44; SDAI&#44; CDAI&#41; or at least their individual components collected &#40;VAS&#44; joint counts&#44; acute phase reactants&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18&#46; It is recorded in the medical history that therapy was intensified according to the pre-established target&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">19&#46; It is recorded in the medical history that the patient was informed about target-based therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&#46; The patient was prescribed double or triple therapy with conventional DMDs before prescribing the first biological agent&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">21&#46; The patient was prescribed a second conventional DMD in monotherapy or combined therapy before the first biological agent was prescribed&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">22&#46; A chest X-ray and PPD were performed before starting the first biological agent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">23&#46; HBV&#44; HCV and HIV serologies were taken before the first biological agent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24&#46; The patient was monitored every 6&#8211;8 months after appropriate control of the disease was achieved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">25&#46; Radiological monitoring was performed every 3&#8211;12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">26&#46; Other imaging techniques were performed&#44; such as ultrasound or magnetic resonance&#44; to monitor subclinical inflammatory activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">27&#46; It is recorded in the medical history that the patient&#39;s comorbidities were considered when designing the treatment and setting the therapeutic target&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">28&#46; High blood pressure was recorded in the medical history&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">29&#46; It is recorded in the medical history that dyslipidaemia was considered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">30&#46; It is recorded in the medical history that diabetes mellitus was considered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">31&#46; It is recorded in the medical history that flu vaccination was recommended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">32&#46; It is recorded in the medical history that pneumococcal vaccination was recommended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">33&#46; It is recorded in the medical history that health staff &#40;nurse or rheumatologist&#41; monitored cardiovascular risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">34&#46; The patient&#39;s weight and height were recorded&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">35&#46; Telephone follow-up was made of compliance with conventional DMD treatment or MTX biological agents or biologics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">36&#46; There is a fast track pathway in the rheumatology department for suspected inflammatory disease&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">37&#46; There is an care mechanism should a stable patient suffer a flare-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Selected Quality Criteria&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Quality criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Quality indicator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Formulae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 1&#46; The Interval between the first rheumatology visit and establishing a diagnosis of RA was less than 2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients for whom the Interval between the first visit to rheumatology and diagnosis of RA was less than 2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients for whom the first consultation in the Rheumatology department and diagnosis of the disease was less than 2 weeks&#46;<br>Denominator&#58; total patients &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 2&#46; The interval between the first rheumatology visit and starting MTX or the first conventional DMD was less than 2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients for whom the interval between the first rheumatology visit and starting treatment with a first DMD was less than 2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients for whom the interval between the first consultation with the rheumatology department and starting treatment with a first DMD was less than 2 weeks<br>Denominator&#58; total patients &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 3&#46; Patients with RA who are smokers should receive personalised advice on smoking cessation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients who are smokers whose rheumatologist offered them personalised advice on smoking cessation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical histories record that they were offered advice on smoking cessation<br>Denominator&#58; total patients recorded as smokers in their medical histories &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 4&#46; It is recorded in the medical history that the patient was advised to achieve and maintain an appropriate weight<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical histories record that their rheumatologist offered them advice on weight control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical histories record that they were advised to achieve and maintain an appropriate weight<br>Denominator&#58; total patients &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 5&#46; It is recorded in the medical history that an explicit assessment was made of factors of poor prognosis as a determining element in the choice of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that their disease activity was explicitly evaluated by means of a joint count &#40;number of painful joints and number of swollen joints&#41;&#44; the patient&#39;s overall assessment using the patient&#39;s visual analogue score &#40;VAS&#41; and acute phase reactants &#40;ESR and CRP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical history records that poor prognosis factors were included<br>Denominator&#58; total patients &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 6&#46; It is recorded in the medical history that an explicit assessment of activity was made as a determining element in the choice of treatment<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that their disease activity was explicitly evaluated by means of a joint count &#40;number of painful joints and number of swollen joints&#41;&#44; the patient&#39;s overall assessment using the patient&#39;s visual analogue score &#40;VAS&#41;&#44; and acute phase reactants &#40;ESR and CRP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical history records that their disease activity was assessed<br>Denominator&#58; total patients &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 7&#46; A chest X-ray was performed before MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that a chest X-ray was performed in the two months before starting treatment with MTX&#46; It is considered to have been &#8220;recorded&#8221; in the medical history when their rheumatologist explicitly recorded it in writing or if there is a chest-X-ray dated before &#40;2 months&#41; starting treatment with MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients with a medical history recording that a chest X-ray was performed &#40;within 2 months&#41; before starting treatment with MTX<br>Denominator&#58; All the patients who started treatment with MTX &#42; 100<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 8&#46; Folic acid or folinic acid was prescribed if MTX has been prescribed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that they were prescribed folic acid or folinic acid if they have been prescribed MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients prescribed folic acid or folinic acid<br>Denominator&#58; total patients starting treatment with MTX &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 9&#46; Glucocorticoids were not prescribed in doses above 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day of prednisone or the equivalent for periods longer than one month&#46; Methylprednisolone at a dose of 8<span class="elsevierStyleHsp" style=""></span>mg&#47;day is considered a glucocorticoid equivalent to prednisone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients who were not prescribed glucocorticoids in doses above 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day of prednisone or methylprednisolone at doses above 8<span class="elsevierStyleHsp" style=""></span>mg&#47;day for a period exceeding one month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients who were not prescribed glucocorticoids at doses above 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day of prednisone or methylprednisolone at 8<span class="elsevierStyleHsp" style=""></span>mg&#47;day during a period exceeding one month<br>Denominator&#58; total patients prescribed glucocorticoids &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 10&#46; It is recorded in the medical history that the dose of MTX was increased to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;week before deciding an inadequate response to MTX&#44; in the absence of adverse effects that made it necessary to discontinue MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose dose of MTX was increased to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;week before an inadequate response to MTX was decided&#44; in the absence of adverse effects making it necessary to discontinue the drug&#46; An inadequate response is determined by clinical judgement&#46; The adverse effects associated with MTX are&#58; alopecia&#44; nausea&#44; vomiting&#44; diarrhoea&#44; ulcerative stomatitis&#44; oral aphtha&#44; gingivitis&#44; glossitis&#44; abdominal discomfort&#44; sexual impotence in males&#44; reduced libido&#44; headache and dizziness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical history records that their dose of MTX was increased to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;week<br>Denominator&#58; total patients with an inadequate response to MTX&#44; in the absence of adverse effects that made it necessary to discontinue treatment with MTX &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 11&#46; The MTX administration route was recorded&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records the administration route of MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical history records the administration route of MTX<br>Denominator&#58; total pacientes prescribed MTX &#42; 100&#46; In order to assess this indicator all the times that MTX was administered over the study period will be considered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 12&#46; It is recorded in the medical history that the patient was monitored every month until remission or low disease activity according to DAS28&#44; CDAI&#44; SDAI or EULAR remission criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that they were monitored using one of the following indices &#40;DAS28&#44; CDAI&#44; SDAI&#41; or EULAR criteria every 4 weeks&#44; until remission or low disease activity&#46; Clinical remission is considered with DAS28<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;4&#44; CDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;8 or SDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>3&#46;3&#44; and low disease activity DAS28<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>3&#46;2&#44; CDAI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;8&#8211;10 or SDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>11&#46; The definition of remission according to EULAR criteria can be categorical&#44; when all of the following must be met&#58; painful joint<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>1&#44; swollen joints<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>1&#44; CRP<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; overall patient&#39;s assessment<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>1&#44; on a scale of 0&#8211;10&#44; or can be based on an index &#40;SDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose disease activity was monitored using DAS28&#44; CDAI&#44; SDAI&#44; every 4 weeks&#44; from the start of treatment<br>Denominator&#58; total patients whose disease was not monitored &#40;using DAS28<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3&#46;2 or SDAI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>11&#41; before starting disease-modifying treatment and achieving remission or low disease activity &#42; 100<br>The disease-modifying treatment included conventional DMDs &#40;MTX&#44; LFN&#44; SFZ and HCQ&#41; and biological therapy &#40;INF&#44; ETN&#44; ADA&#44; CERTO&#44; GOL&#44; ABA&#44; TCZ&#44; RTX&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 13&#46; It is recorded in the medical history that injections were prescribed for inflamed joints as part of good systemic control of the disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients with good systemic control of their disease prescribed injections for inflamed joints&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients with good systemic control<br>Denominator&#58; total patients prescribed injection of painful joints &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 14&#46; It is recorded in the medical history that activity indices were used in visits or at least their individual components collected&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records the indices of disease activity &#40;DAS28&#44; SDAI&#44; CDAI&#41; or at least all the individual components &#40;VAS&#44; joint counts&#44; acute phase reactants&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical history records their disease activity or individual components<br>Denominator&#58; total patients &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 15&#46; It is recorded in the medical history that therapy was intensified according to the pre-established target&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that their therapy was modified when low activity or remission of their disease was not achieved&#46; Clinical remission is considered DAS28<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;4&#44; CDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;8 or SDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>3&#46;3&#44; and low disease activity DAS28<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>3&#46;2&#44; CDAI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;8&#8211;10 or SDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>11&#46; The definition of remission according to EULAR criteria can be categorical&#44; requiring all of the following to be met&#58; painful joint<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>1&#44; inflamed joints<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>1&#44; CRP &#8804; 1<span class="elsevierStyleHsp" style=""></span>mg&#47;dl or the patient&#39;s assessment of the activity<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>1&#44; on a scale of 0&#8211;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical history records that their therapy was modified because low activity or remission of their disease was not achieved&#46; Denominator&#58; total patients with RA &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 16&#46; The patient was prescribed a second conventional DMD in monotherapy or combined therapy before prescribing the first biological agent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients prescribed a second conventional DMD in monotherapy or combined therapy before prescribing the first biological agent&#46; The conventional DMDs are&#58; MTX&#44; LFN&#44; SFZ&#44; HCQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients prescribed a second conventional DMD in monotherapy or combined therapy prior to treatment with biologicals<br>Denominator&#58; total patients prescribed treatment with a biological agent for the first time &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 17&#46; A chest X-ray and PPD were performed before starting the first biological agent<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients who underwent a chest X-ray and PPD &#40;PPD skin test to diagnose tuberculosis infection&#41; before starting the first biological agent&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients who underwent HCV&#44; HBV and HIV serologies before starting the first biological<br>Denominator&#58; total patients prescribed biological therapy for the first time &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 18&#46; HBV&#44; HCV and HIV serologies were taken before the first biological agent<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that serologies were taken &#40;HCV&#44; HBV and HIV&#41; before starting biological therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients who underwent HCV&#44; HBV and HIV serologies dated prior to starting the first biological<br>Denominator&#58; total patients prescribed biological therapy for the first time &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 19&#46; The patient was monitored every 6&#8211;8 months after appropriate control of the disease was achieved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that they attended a check-up at 6&#8211;8 months or earlier after appropriate control of the disease&#46; Appropriate control of the disease is defined as DAS28<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>3&#46;2 or SDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients who attended check-up at 6&#8211;8 months or after appropriate control of the disease<br>Denominator&#58; total number of patients with appropriate control of their disease &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 20&#46; Radiological monitoring was performed at least once a year<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that a hand X-ray was taken at least once in 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients who undergo a hand X-ray&#44; at least once a year<br>Denominator&#58; total patients with RA &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 21&#46; The medical history records that the patient&#39;s comorbidities were considered when designing treatment and setting the therapeutic target&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that a comorbidity affected the choice of a specific RA treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; numbers of patients whose medical history records comorbidities &#40;high blood pressure&#44; diabetes&#44; etc&#46;&#41;<br>Denominator&#58; total patients RA &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 22&#46; High blood pressure was recorded in the medical history&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical histories record high blood pressure<br>Denominator&#58; total patient with RA &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 23&#46; It is recorded in the medical history that dyslipidaemia was considered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records their cholesterol level&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical histories record their cholesterol level<br>Denominator&#58; total patients with RA &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 24&#46; It is recorded in the medical history that diabetes mellitus was considered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records their blood sugar level&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical histories record their blood sugar level<br>Denominator&#58; total patients with RA &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 25&#46; It is recorded in the medical history that annual flu vaccination was recommended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that annual flu vaccination was recommended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients recommended to have an annual flu vaccine<br>Denominator&#58; total patients with RA &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 26&#46; It is recorded in the medical history that pneumococcal vaccination was recommended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that pneumococcal vaccination was recommended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients recommended pneumococcal vaccination<br>Denominator&#58; total patients with RA &#42; 100&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 27&#46; It is recorded in the medical history that health staff &#40;nurse or rheumatologist&#41; monitored cardiovascular risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records that health staff &#40;nurse or rheumatologist&#41; monitored their cardiovascular risk using a cardiovascular risk scale or subclinical atherosclerosis testing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose cardiovascular risk was assessed using a cardio vascular risk scale or subclinical atherosclerosis testing<br>Denominator&#58; total patients with RA &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 28&#46; The patient&#39;s weight was recorded in their medical history&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records an annual weight measurement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical history records an annual measurement of their weight<br>Denominator&#58; total patients &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 29&#46; The patient&#39;s height was recorded in their medical history&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Percentage of patients whose medical history records their height measurement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Numerator&#58; number of patients whose medical history records their height<br>Denominator&#58; total patients &#42; 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 30&#46; There is a fast- track pathway in the rheumatology department for suspected inflammatory disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Presence of a fast- track pathway in the rheumatology department for suspected inflammatory disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Criterion 31&#46; There is a care mechanism should a stable patient suffer a flare-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Presence of a care mechanism in the event of a flare-up of stable RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "etiqueta" => "Table 3"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">RA&#58; rheumatoid arthritis&#59; CDAI&#58; Clinical Disease Activity Index&#59; DAS&#58; Disease Activity Score&#59; VAS&#58; visual analogue scale&#59; DMD&#58; disease modifying drugs&#59; MTX&#58; methotrexate&#59; PPD&#58; purified protein derivative&#59; SDAI&#58; Simple Disease Activity Index&#59; HBV&#58; hepatitis B virus&#59; HCV&#58; hepatitis C virus C&#59; HIV&#58; human immunodeficiency virus&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Relevance</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Feasibility</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; GA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; GA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; The interval between requesting a rheumatology consultation and the first visit to the rheumatologist was less than 4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;5 &#40;4&#46;95&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; The interval between the first rheumatology visit and establishing a diagnosis of RA was less than 2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5 &#40;8&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;5 &#40;5&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; The interval between the first visit to rheumatology and starting MTX or the first conventional DMD was less than 2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;7&#46;75&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5 &#40;5&#46;75&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; It is recorded in the medical history that the patient was advised to stop smoking<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5 &#40;8&#8211;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;7&#46;75&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; It is recorded in the medical history that the patient was advised to achieve and maintain an appropriate weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5 &#40;7&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; It is recorded in the medical history that the patient was advised to maintain good oral health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5 &#40;6&#46;75&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5 &#40;5&#8211;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; It is recorded in the medical history that an explicit assessment was made of factors of poor prognosis as a determining element in the choice of treatment<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#46;75&#8211;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; It is recorded in the medical history that an explicit evaluation of activity was made as a determining element in the choice of treatment<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5 &#40;7&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; A chest X-ray was performed before MTX<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; Folic acid was prescribed if MTX was prescribed<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46; Low doses of glucocorticoids and DMDs were prescribed<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#46;75&#8211;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#46; Glucocorticoids were not prescribed in doses above 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day of prednisone or the equivalent for periods longer than one month<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&#46; It is recorded in the medical history that injections were prescribed for inflamed joints as part of good systemic control of the disease<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&#46; It is recorded in the medical history that the dose of MTX was increased to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;week before deciding an inadequate response to MTX&#44; in the absence of adverse effects that made it necessary to discontinue MTX<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#46; The MTX administration route was recorded<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&#46; It is recorded in the medical history that the patient was monitored every month until remission or low disease activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#46;75&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;5&#46;75&#8211;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&#46; It is recorded in the medical history that activity indices were used at visits &#40;DAS28&#44; SDAI&#44; CDAI&#41; or at least their individual components collected &#40;VAS&#44; joint counts&#44; acute phase reactants&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18&#46; It is recorded in the medical history that therapy was intensified according to the pre-established target<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;7&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5 &#40;7&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">19&#46; It is recorded in the medical history that the patient was informed about target-based therapy<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#46;75&#8211;8&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5 &#40;6&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&#46; The patient was prescribed double or triple therapy with conventional DMDs before prescribing the first biological agent<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;4&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">21&#46; The patient was prescribed a second conventional DMD in monotherapy or combined therapy before prescribing the first biological agent<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#46;75&#8211;8&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">22&#46; A chest X-ray and PPD were performed before starting the first biological agent<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">23&#46; HBV&#44; HCV and HIV serologies were taken before the first biological agent<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;8&#46;75&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24&#46; The patient was monitored every 6&#8211;8 months after appropriate control of the disease was achieved<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#46;75&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">25&#46; Radiological monitoring was performed every 3&#8211;12 months<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#46;75&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5 &#40;7&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">26&#46; Other imaging techniques were performed&#44; such as ultrasound or magnetic resonance&#44; to monitor subclinical inflammatory activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;6&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#8211;7&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">27&#46; It is recorded in the medical history that the patient&#39;s comorbidities were considered when designing the treatment and setting the therapeutic target<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5 &#40;8&#46;75&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5 &#40;7&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">28&#46; High blood pressure was recorded in the medical history<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;8&#46;75&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">29&#46; It is recorded in the medical history that dyslipidaemia was considered<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">30&#46; It is recorded in the medical history that diabetes mellitus was considered<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5 &#40;8&#46;75&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">31&#46; It is recorded in the medical history that a flu vaccination was recommended<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#46;75&#8211;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">32&#46; It is recorded in the medical history that pneumococcal vaccination was recommended<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;7&#46;75&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">33&#46; It is recorded in the medical history that health staff &#40;nurse or rheumatologist&#41; monitored cardiovascular risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5 &#40;6&#8211;8&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">34&#46; The patient&#39;s weight and height were recorded<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">35&#46; Telephone follow-up was made of compliance with conventional DMD treatment or MTX biological agents or biologics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">36&#46; There is a fast-track pathway in the rheumatology department for suspected inflammatory disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;8&#46;75&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5 &#40;6&#8211;8&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">37&#46; There is a care mechanism should a stable patient suffer a flare-up<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Relevance</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Feasibility</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; GA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; GA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; The interval between requesting a rheumatology consultation and the first visit to the rheumatologist was less than 4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; The interval between the first Rheumatology visit and establishing a diagnosis of RA was less than 2 weeks<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;8&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; The interval between the first visit to rheumatology and starting MTX or the first conventional DMD was less than 2 weeks<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;8&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; It is recorded in the medical history that the patient was advised to achieve and maintain an appropriate weight<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; It is recorded in the medical history that the patient was advised to maintain good oral health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;5&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; It is recorded in the medical history that the patient was monitored every month until remission or low disease activity<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;8&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; It is recorded in the medical history that the patient was informed about target-based therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;6&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; The patient was prescribed double or triple therapy with conventional DMDs before prescribing the first biological agent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; Other imaging techniques were performed&#44; such as ultrasound or magnetic resonance&#44; to monitor subclinical inflammatory activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;6&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; It is recorded in the medical history that health staff &#40;nurse or rheumatologist&#41; monitored cardiovascular risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5 &#40;6&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46; Telephone follow-up was made of compliance with conventional DMD treatment or MTX biological agents or biological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#46; There is a fast track pathway in the rheumatology department for suspected inflammatory disease<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Drug management of early rheumatoid arthritis-2008"
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                        0 => array:2 [
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                          "autores" => array:2 [
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                      "doi" => "10.1016/j.berh.2008.08.003"
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                        "tituloSerie" => "Best Pract Res Clin Rheumatol"
                        "fecha" => "2009"
                        "volumen" => "23"
                        "paginaInicial" => "93"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "EULAR recommendations for the management of early arthritis&#58; report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics &#40;ESCISIT&#41;"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "C&#46; Lukas"
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                            4 => "F&#46; Breedveld"
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                      "doi" => "10.1136/ard.2005.044354"
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                        "tituloSerie" => "Ann Rheum Dis"
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                        "paginaInicial" => "34"
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                      "doi" => "10.1016/j.berh.2006.08.011"
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                      "titulo" => "Rheumatoid arthritis&#58; physician performance measurement set"
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