Rheumatologists Enhance Quality of Care for Patients with Rheumatoid Arthritis

In a historical cohort study of, MacLean, et al (JAMA 284:984-992, 2000) assess the quality of health care received by1355 adult rheumatoid arthritis (RA) patients for their arthritis, comorbid diseases, and health care maintenance and to determine the impact of specialty care.

Patients were enrolled in the fee-for-service or discounted fee-for-service plans of a nationwide US insurance company and followed up through demographic, claims submitted, and pharmacy data files between 1991 and 1995. Quality of care was analyzed by process measures established by the American College of Rheumatology, American College of Cardiology, American Diabetes Association, etc. Aggregate scores for each of the 3 domains were developed and averaged for each person-year to determine the overall performance score for each domain. This score represented the percentage of recommended procedures in the domain that an eligible patient received during a person-year.

Aggregate scores for recommended processes performed were 62% for arthritis, 52% for comorbid disease care and 42% for health care maintenance. Overall, 57% of recommended care was performed across all domains. Within each of the domains, patients that had specialty care had 30-187% higher performance scores than those that did not (P<.001). No significant differences in performance scores were found between patients receiving care from both a relevant specialist and a primary care physician and patients receiving care from only a relevant specialist.

Editorial Comment: This study showed that patients received suboptimal care not only for RA but for their comorbid conditions and health maintenance issues, as well. Specialists involvement resulted in improved care not only for the RA, but for patients’ comorbid conditions as well. These studies emphasize the importance of specialists in improving outcomes for patients with complex conditions such as RA.