Pos1090 implementation of quality standards for health care of patients with rheumatoid arthritis: first results from the national database of the german collaborative arthritis centres

Background Despite the establishment of national and international recommendations for the management of patients with rheumatoid arthritis (RA), remediable deficits in the quality of care (QoC) still exist. On behalf of the German Society for Rheumatology, with participation of the patient organization Deutsche Rheuma-Liga, eight Quality standards (QS) have been developed to improve the QoC in Germany. The QS can be used to determine and quantitative gaps in QoC in respect to time to diagnosis, use of glucocorticoids, rates of remission and impairments in physical function [1]. Objectives To quantify gaps in QoC based on five QS in patients with RA for whom data from the National Database of the German Collaborative Arthritis Centres (NDB) exists. Methods In 2020, 4863 patients with RA from 12 Rheumatology centres were followed in the NDB. Five QS were reviewed: (QS1) How often was RA diagnosed within 8 weeks of symptom onset? (QS2) How many patients are in remission? (QS3) How many patients are in glucocorticoid-free remission? (QS4) How many patients who were not in remission had their medication adjusted? (QS5) How many patients with impairments in physical function received physiotherapy, functional training, and/or rehabilitation? Remission was investigated both by DAS28 and by CDAI cut-offs. Impairments in physical function were assessed with the FFbH (≤70% of full function). Switches, additions, or dose increases of disease-modifying antirheumatic drug (DMARD) were considered adjustment of medication. Individual components of the DAS28 are reported to determine reasons for not achieving remission. Results Fulfillment of QS (Figure 1) was investigated in 4863 patients (Table 1). In 2020, 76 patients had their first contact to rheumatologist and 30 were seen by a rheumatologist within 8 weeks (39%). Of 61 patients with available diagnosis date, 25 (41%) were diagnosed within 8 weeks. 1523 of 3410 patients with available DAS28 were in DAS28 remission (45%) and 933 of 4023 patients with available CDAI were in CDAI remission (23%). 1155 of 1520 patients in DAS28 remission and 789 of 930 RA patients in CDAI remission were glucocorticoid-free (76%/85%). 373 of 1676 patients who were not in DAS28 remission had adjustment of medication (22%). Patients without therapy adjustment had fewer clinical signs of inflammatory activity (SJC 1.3 vs. 2.6, TJC 2.6 vs. 3.7, ESR 25.7 vs. 27.4, Physician global 1.8 vs. 2.8, Patient disease activity 4.1 vs. 4.8) compared to patients with adjustment of medication. 68 of 149 patients with high disease activity (DAS28>5.1) had adjustment of medication (46%). 377 of 772 patients with impairments in physical function and information on physiotherapy received physiotherapy (49%), 32 of 767 patients with data on functional training received functional training (4%) and 117 of 1175 patients with data on rehabilitation received rehabilitation (10%). Table 1. Patient characteristics, n=4863 Female sex (%) 74 Age, mean in years 63 Disease duration, mean, years 14 ACPA or RF positive (%) 72 DAS28, mean (n=3,410) 2.9 CDAI, mean (n=4,023) 7.7 TJC, mean 1.6 SJC, mean 1.0 ESR, mean in mm/h 19.1 Patient global disease activity, mean 3.5 Physician global disease activity, mean 1.5 Functional assessment (FFbH 0-100), mean (n=4526) 75.4 cs/bDMARDs (%) 70/ 29 Glucocorticoids (%) 35 First Rheumatology visit in 2020, n 76 Duration of symptoms, mean/median, months 20.2/4.0 Rheumatologist contact within 8 weeks, n (%) 30 (39%) Diagnosis within 8 weeks, n (%) (n=61 with available diagnosis date) 25 (41%) Figure 1. Fulfillment of quality standards (%) Conclusion With the new QS, QoC of patients with RA can be measured in a standardized form. While some results reflect high quality of care, other QSs point to opportunities for improvement. The implementation of the QS enables both a comparative evaluation at facility level and a general rheumatology health care outcome. This will help to optimize the QoC for patients with RA in Germany. Reference [1]PMID 34652486 Acknowledgements We thank all participating rheumatologists and patients for their valuable contributions. The NDB is supported by the Association of Regional Cooperative Rheumatology Centres, the German Society for Rheumatology and joint contributions to the Rheumatological Training Academy and the DRFZ by the following members of the Working Group of Corporate Members of the German Society for Rheumatology: AbbVie, AstraZeneca, BMS, GALAPAGOS, GSK, Lilly, Medac, MSD, Pfizer, Sanofi-Aventis and UCB. Disclosure of Interests Katinka Albrecht: None declared, Katja Thiele: None declared, Martin Aringer: None declared, Johanna Callhoff Speakers bureau: Janssen-Cilag GmbH, Kirsten Karberg: None declared, Klaus Krueger: None declared, Jürgen Lakomek: None declared, Hanns-Martin Lorenz: None declared, Martin Rudwaleit Speakers bureau: Abbvie, Boehringer, Galapagos, Janssen, Lilly, Novartis, Pfizer, UCB, Rotraud Schmale-Grede: None declared, Matthias Schneider: None declared, Susanna Spaethling-Mestekemper: None declared, Christof Specker: None declared, Silke Zinke: None declared, Jürgen Braun: None declared, Uta Kiltz: None declared.