Table 3.
Quality indicators for osteoarthritis care
| Indicator | Source(s) | Description and/or numerator, denominator of indicator | Scientific validity | Reliability |
|---|---|---|---|---|
| Structure indicators | ||||
| Access | EUMUSC.net, 2012 | Description: All professionals managing patients with osteoarthritis at a primary care setting should have continuous access to education on important preventive and therapeutic strategies in the management of osteoarthritis | High content and face validity | No reliability testing identified |
| Waiting time | EUMUSC.net, 2012 | Description: If a patient diagnosed with osteoarthritis has been referred to an orthopaedic surgeon, then the waiting time from first referral should not exceed 3 months | High content and face validity | No reliability testing identified |
| Process indicators | ||||
| Assessment | PCPI, 2006; MacLean, 2007; Pencharz, 2004 | Numerator: Number of patients from the denominator for whom a physical examination (visual inspection, palpation, range of motion) of the involved joint was performed during the initial visit | High content validity | Questionnaire-based test–retest aκ = 0.34, 63% exact agreement (21) |
| Denominator: Number of patients aged 18 years and older with a diagnosis of symptomatic osteoarthritis during the measurement period | ||||
| PCPI, 2006; MacLean, 2007; EUMUSC.net, 2012; Pencharz, 2004; NQF endorsed | Numerator: Number of patients from the denominator with a documentation of assessed pain annually and when new to a primary care provider | High content and face validity | No reliability testing identified | |
| Denominator: Number of patients aged 18 years and older with a diagnosis of symptomatic osteoarthritis during the measurement period | ||||
| PCPI, 2006; MacLean, 2007; EUMUSC.net, 2012; Pencharz, 2004; NQF endorsed | Numerator: Number of patients from the denominator with a documentation of assessed functional status annually and when new to a primary care provider | High content and face validity | Questionnaire-based test–retest κ = 0.53, 62% exact agreement (21) | |
| Denominator: Number of patients aged 18 years and older with a diagnosis of symptomatic osteoarthritis during the measurement period | ||||
| Education | EUMUSC.net, 2012; Pencharz, 2004 | Numerator: Number of patients from the denominator who have been given individually tailored education about the natural history, treatment and self- management of the disease at least once | High content and face validity | No reliability testing identified |
| Denominator: Number of patients aged 18 years and older with a diagnosis of osteoarthritis for >3 months during the measurement period | ||||
| Weight loss | Pencharz, 2004; MacLean, 2007 | Numerator: Number of patients from the denominator who have been advised annually to lose weight | High content validity | Questionnaire-based test–retest κ = 0.80, 90% exact agreement (21) |
| Denominator: Number of patients aged 18 years and older with a diagnosis of osteoarthritis who are overweight during the measurement period | ||||
| Pencharz, 2004; Darzi, 2008 | Numerator: Number of patients from the denominator who have been advised at least annually to lose weight and the benefit of weight loss on the symptoms of osteoarthritis have been explained | High content validity | No reliability testing identified | |
| Denominator: Number of patients aged 18 years and older with a diagnosis of symptomatic osteoarthritis who are overweight during the measurement period | ||||
| Pencharz, 2004; EUMUSC.net, 2012 | Numerator: Number of patients from the denominator who received referral to a weight loss programme | High content and face validity | Questionnaire-based test–retest κ = 0.80, 90% exact agreement (21) | |
| Denominator: Number of patients aged 18 years and older with a diagnosis of symptomatic osteoarthritis who are overweight for 3 years | ||||
| Therapeutic exercise | PCPI, 2006; EUMUSC.net, 2012; Pencharz, 2004; MacLean, 2007 | Numerator: Number of patients from the denominator who has no contraindication to exercise and are physically and mentally able to exercise was offered an individualized exercise programme or was referred to a relevant health professional | High content and face validity | Questionnaire-based test–retest κ = 0.34, 63% exact agreement (21) |
| Denominator: Number of patients aged 18 years and older with a diagnosis of symptomatic osteoarthritis for >3 months during the measurement period | ||||
| Assessment for use of anti-inflammatory medications | PCPI, 2006; NQF endorsed | Numerator: Number of patients from the denominator with a documentation of the assessment for use of anti-inflammatory or analgesic over-the-counter medications | High content and face validity | No reliability testing identified |
| Denominator: Number of patients aged 18 years and older with a diagnosis of osteoarthritis during the measurement period | ||||
| PCPI, 2006; MacLean, 2007; EUMUSC.net, 2012 | Numerator: Number of patients from the denominator taking a NSAID with a documented assessment for gastrointestinal and renal risk factors | High face validity | Questionnaire-based test–retest κ = 0.45, 64% exact agreement (21) | |
| Denominator: Number of patients aged 18 years and older with a diagnosis of osteoarthritis during the measurement period | ||||
| First-line pharmacological therapy | MacLean, 2007; Pencharz, 2004 | Numerator: Number of patients from the denominator who were prescribed acetaminophen first, unless there is a documented contraindication to use | High content validity | Questionnaire-based test–retest κ = 0.45, 68% exact agreement (21) |
| Denominator: Number of patients aged 18 years and older with a diagnosis of osteoarthritis who were started on pharmacological therapy, during the measurement period | ||||
| MacLean, 2007 | Numerator: Number of patients from the denominator who have been advised of the risk of liver toxicity | High content validity | No reliability testing identified | |
| Denominator: Number of patients aged 18 years and older with a diagnosis of osteoarthritis taking high-dose acetaminophen (>3 g/day), during the measurement period | ||||
| Pencharz, 2004 | Description: If oral pharmacologic therapy for osteoarthritis is changed from acetaminophen to a different oral agent, then there should be evidence that the patient has had a trial of maximum dose acetaminophen (suitable for age and comorbid conditions) | High content validity | No reliability testing identified | |
| Gastroprotection | PCPI, 2006; MacLean, 2007 | Numerator: Number of patients from the denominator taking a NSAID in combination with misoprostol or proton pump inhibitor | High content validity | Questionnaire-based test–retest κ = 0.45, 64% exact agreement (21) |
| Denominator: Number of patients aged 18 years and older with a diagnosis of osteoarthritis and a risk factor for gastrointestinal bleeding during the measurement period | ||||
| Assistive devices | MacLean, 2007; Pencharz, 2004; EUMUSC.net, 2012 | Numerator: Number of patients from the denominator for whom the need for ambulatory assistive devices has been assessed | High content and face validity | Questionnaire-based test–retest κ = 0.35, 68% exact agreement (21) |
| Denominator: Number of patients aged 18 years and older with a diagnosis of osteoarthritis who have reported difficulties of walking to accomplish activities of daily living during the measurement period | ||||
| Surgery | MacLean, 2007; Pencharz, 2004; EUMUSC.net, 2012; PCPI, 2006 | Numerator: Number of patients from the denominator who have been referred to an orthopaedic surgeon | High content and face validity | Questionnaire-based test–retest κ = 0.62, 76% exact agreement (21) |
| Denominator: Number of patients aged 18 years and older with a diagnosis of symptomatic osteoarthritis who failed to respond to pharmacological/non-pharmacological treatment during the measurement period | ||||
| Outcome indicators | ||||
| Functional improvement | EUMUSC.net, 2012 | Numerator: Number of patients from the denominator who have reported improvement of functional ability by 20% within 3 months after initiation/change of pharmacological/ non-pharmacological treatment | High content and face validity | No reliability testing identified |
| Denominator: Number of patients aged 18 years and older with a diagnosis of symptomatic osteoarthritis and functional limitation with initiation/change of pharmacological/non-pharmacological treatment during the measurement period | ||||
| Pain reduction | EUMUSC.net, 2012 | Numerator: Number of patients from the denominator who have reported reduction of pain level by 20% within 3 months after initiation/change of pharmacological/non-pharmacological treatment | High content and face validity | No reliability testing identified |
| Denominator: Number of patients aged 18 years and older with a diagnosis of symptomatic osteoarthritis initiation/change of pharmacological/non-pharmacological treatment during the measurement period | ||||
NSAID, Non-steroidal anti-inflammatory drug.
aκ = Cohen’s kappa coefficient.