Table 1.
Quality indicators proposed for the monitoring of lupus patients I agree with comment to avoid repetition in statements.
| Quality indicator (QI) | Description | Who measures it? | When is it measured? | Where does the data come from? | |
|---|---|---|---|---|---|
| QI 1 | IF a patient is diagnosed with SLE, THEN the treating physician should assess and record disease activity using a validated index at each visit. | % of total SLE patients registered in a unit (service, department, clinic) in whom a validated activity index is used at each visit with a physician | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa |
| QI 2 | IF a patient is diagnosed with SLE, THEN the treating physician should assess and record disease damage by the SLICC/ACR damage index annually. | % of total patients registered in a Unit (service, department, clinic) in whom a the Systemic Lupus International Collaborating Clinics (SLICC/ACR) damage index is used once a year | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa |
| QI 3 | IF a patient is diagnosed with SLE, THEN he/she should provide an evaluation of his/hers quality of life at each visit. | % of patients to whom is asked a judgment on their quality of life either on a visual analogue scale from 0 to 10 or using any validated index (SF36, SLE-QoL) | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa |
| QI 4 | IF a patient is diagnosed with SLE, THEN the treating physician should assess the presence of drug toxicity at each visit, and record the data in the clinical chart. Alternatively, the physician should record the absence of drug toxicity. | % of SLE patients for whom the presence/absence of side effects from drugs is reported in clinical charts at each visit | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa |
| QI 5 | IF a patient is diagnosed with SLE, THEN the treating physician or a specialized nurse should record the presence of comorbid conditions at each visit. | % of total patients for whom comorbidities are recorded in the clinical charts (Absence of comorbidities should be also recorded) | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa |
| QI 6 | If a patient is diagnosed with SLE and treated with hydoxycloroquine/chloroquine THEN he/she should undergo an ophthalmologic assessment according with the existing guidelines. and this should be documented in the clinical chart. | % percentage of patients treated with HCQ and undergoing eye assessment | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa, Opticians, Ophtalmologist report |
| QI 7 | If a patient is diagnosed with SLE and treated with corticosteroids THEN he/she should undergo an ophthalmologic assessment for the presence of cataracts and/or glaucoma according with the existing guidelines. This should be documented in the clinical chart | Percentage of patients treated with corticosteroids and undergoing eye assessment for the presence of cataracts/glaucoma | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa, Opticians, Ophtalmologist report |
| QI 8 | IF a patient is diagnosed with SLE THEN at least every six months the rheumatologist should request the following laboratory assessment: complete blood count, erythrocyte sedimentation rate, albumin, serum creatinine or e-GFR, urinalysis and protein/creatinine ratio (or 24 h proteinuria), C3 and C4 | Percentage of patients in whom the listed exams are performed at each assessment | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa |
| QI 9 | If a patient is diagnosed with SLE and is prescribed high dose corticosteroids and/or immunosuppressive drugs THEN, based on patient’s history, the rheumatologist should consider the evaluation of HCV, HBV and tuberculosis screening and record the results into the clinical chart before starting therapy | Percentage of patients with SLE and treated with high dose corticosteroids and/or immunosuppressive drugs for whom the presence/absence of chronic infectious diseases is documented | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa |
| QI 10 | If a patient is diagnosed with SLE, THEN the patient’s history of vaccinations should be documented. Patients should be vaccinated against influenza and pneumococcus (preferably without adjuvant), if there are no contraindication to immunization. | Percentage of patients with SLE that receive vaccination against influenza and pneumococcus | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa |
| QI 11 | If a patient is diagnosed with SLE, THEN the following autoantibodies should be evaluated at the first evaluation: ANA, anti-dsDNA, anti-Ro, anti-La, anti-RNP, anti-Sm, anti-phospholipid | Percentage of patients with SLE that at initial assessment are evaluated for ANA, anti-dsDNA, anti-Ro, anti-La, anti-RNP, anti-Sm, anti-phospholipid | TPhy, RS, HM/EAu | Y or at specific CSAu | CRa |
Abbreviations: SLE, systemic lupus erythematosus; TPhy, treating physician; RS, Rheumatology staff; HM/EAu, Hospital Management/External Auditor; Y, Yearly; CSAu, cross-sectional audits; CR, clinical records; HCQ, hydroxy-chloroquine; GFR, glomerular fraction rate, HCV, hepatitis C virus, HBV hepatitis B virus.
a
Either paper or computerized.