Understanding the Effect of Meeting Performance Measures on the Outcomes of Joint Replacement in Rheumatoid Arthritis: A Population-Based Study in British Columbia, Canada.

Abstract

Objective: Canadian performance measures (PMs) evaluate the quality of rheumatoid arthritis (RA) care; however, limited evidence exists linking these process measures to long-term patient outcomes. This research evaluated the effect of meeting PMs in early RA on 10-year risk of total joint replacement (TJR) of any joint.

Methods: This was a retrospective propensity score-matched population-based cohort study in people with RA diagnosed between 2000 and 2008 who were followed until 2019. The exposure of interest was meeting the PMs within 2 years of diagnosis. Cox proportional hazard models were developed to examine the 10-year risk of TJR in 4 matched cohorts where PMs were met vs not met. PMs included access to rheumatology care, retention in care, early disease-modifying antirheumatic drug (DMARD) use, and ongoing DMARD therapy.

Results: Among 19,765 individuals with RA, 44.78% had access to a rheumatologist within 1 year of diagnosis and 24.91% were retained in care; only 24.30% were dispensed a DMARD within 30 days, and 32.66% received a DMARD annually for the first 2 years. Meeting the PMs was associated with a neutral effect on risk of TJR at 10 years in our propensity score-matched analysis for 3 of the PMs, whereas a slightly elevated risk (hazard ratio 1.19, 95% CI 1.03-1.37) was shown for those receiving a DMARD at least annually.

Conclusion: There were deficits in RA care identified at a population level; however, no clear protective effect of adherence to PMs was found. Future measure development efforts should focus on PMs with a greater effect on patient outcomes.