Improving Systemic Sclerosis Quality of Care.

Abstract

Objective: Systemic sclerosis (SSc) is a multisystemic autoimmune disease with high morbidity and healthcare costs. Inconsistent quality of care delivery, including inadequate screening and monitoring, necessitates improvement. This study aimed to enhance the uptake of validated quality indicators (QIs) for SSc.

Methods: An interrupted time series study was conducted at 4 scleroderma clinics across 2 hospitals using the Model for Improvement methodology, employing Plan-Do-Study-Act (PDSA) cycles. A retrospective chart review assessed baseline frequencies of selected QIs. The primary aim was to increase rates of 7 baseline and 5 follow-up QIs to 80%. Root-cause analysis identified barriers to QI uptake, leading to interventions including provider education, equipment procurement, and care standardization with reminder systems. Real-time data tracking was facilitated through run charts.

Results: The average completion rate for baseline QIs increased from 48% to 83% over 8 months, with sustained improvements post-PDSA cycle 3. Monitoring and treatment QI completion improved from 40% to 77%. Process measures saw increases in completion rates: baseline spirometry and diffusing lung capacity for carbon monoxide rates improved from 63.5% to 92%, documented counseling to perform weekly blood pressure self-measurement increased from 19% to 86.6%, referrals to hand range-of-motion exercise programs rose from 54% to 92%, baseline creatine kinase measurement rates increased from 52% to 88%, and oxygen saturation documentation rose from 31% to 65%. Stakeholders reported high satisfaction (median rating of 4), with minimal additional time per patient (median 2.5 minutes).

Conclusion: This QI study significantly improved SSc care through low-cost, applicable interventions, setting a precedent for future work on long-term sustainability and broader application in chronic disease management.