Quality Indicators for the Care of Osteoarthritis in Vulnerable Elders

Osteoarthritis (OA) is the most common chronic disease affecting older persons. Depending on the method of evaluation and the diagnostic criteria used, estimates of symptomatic disease prevalence range from 50% to 80% of the elderly population. Rheumatoid arthritis affects 1% of the adult population. Half of all disability in older persons has been attributed to arthritis. OA is associated with pain, functional disability, and being homebound. Several studies have demonstrated regional and subspecialty variations in the use of pharmacological, nonpharmacological, and surgical treatment modalities. This article identifies quality indicators (QIs) that may be used to assess the prevention and treatment of OA, investigate the relationship between processes and outcomes of care, and review the available data in support of each of these indicators. METHODS: The methods used to develop these measures are detailed in an accompanying manuscript in this issue. This manuscript updates and expands on information from two earlier systematic reviews. Seventy-seven additional articles were considered for this review; 17 identified using a Web search, nine through reference mining, and 40 through the Assessing Care of Vulnerable Elders (ACOVE)-3 literature searches. Eleven additional articles were included after peer review. RESULTS: Of the 23 potential QIs, the expert panel process judged 13 to be valid, and 10 were rejected. The literature summaries that support each of the indicators judged to be valid in the expert panel process are described. Five of the indicators pertain to the use of analgesic medications and have broad application beyond OA. These were moved to the Medication Use section. In addition, one indicator was moved to Screening and Prevention.