Improving Systemic Sclerosis Quality of Care.

Abstract

Objective: Systemic sclerosis (SSc) is a multi-systemic autoimmune disease with high morbidity and healthcare costs. Inconsistent quality 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 seven baseline and five 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 via run charts.

Results: The average completion rate of baseline QIs increased from 48% to 83% over eight months, with sustained improvements post-PDSA cycle 3. Monitoring and treatment QI completion improved from 41% to 77%. Process measures saw increases: baseline spirometry and DLCO rates improved from 63.5% to 92%, documented weekly BP self-measurement counseling increased from 18.8% to 86.6%, referrals to hand motion exercise programs rose from 53.6% to 92%, baseline CK measurement rates increased from 52.1% to 88%, and oxygen saturation documentation rose from 31.1% 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.