Cover: Quality of Care Indicators for Gout Management

Quality of Care Indicators for Gout Management

Published in: Arthritis and Rheumatism, v. 50, no. 3, Mar. 2004, p. 937-943

Posted on 2004

by Ted R. Mikuls, Catherine MacLean, Jason Olivieri, Fausto Patino, Jeroan J. Allison, John T. Farrar, Warren B. Bilker, Kenneth G. Saag

OBJECTIVE: Despite the significant health impact of gout, there is no consensus on management standards. To guide physician practice, the authors sought to develop quality of care indicators for gout management. METHODS: A systematic literature review of gout therapy was performed using the Medline database. Two abstractors independently reviewed each of the articles for relevance and satisfaction of minimal inclusion criteria. Based on the review of the literature, 11 preliminary quality indicators were developed and then reviewed and refined by an initial feasibility panel of community and academic rheumatologists. A twelfth indicator was added at the request of the first panel. Using a modification of the RAND/University of California at Los Angeles appropriateness method (bridging teleconference and white-board Internet technology were added), a second expert panel rated each of the proposed indicators for validity using a 9-point scale, in which ratings of 1-3, 4-6, and 7-9 were considered invalid, indeterminate, and highly valid, respectively. Indicators were considered valid if the median panel rating was > or =7 and there was no evidence of panel disagreement (defined to occur when 2 of 6 panelists provided a validity rating of 1-3 and 2 panelists provided a validity rating of 7-9). RESULTS: Ten of the 12 draft indicators were rated to be valid by our second expert panel. Validated indicators pertained to 1) the use of urate-lowering medications in chronic gout, 2) the use of antiinflammatory drugs, and 3) counseling on lifestyle modifications. CONCLUSION: Using a combination of evidence and expert opinion, 10 indicators for quality of gout care were developed. These indicators represent an important initial step in quality improvement initiatives for gout care.

This report is part of the RAND external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.