Musculoskeletal conditions health care quality indicators (WP6)

“We can only be sure to improve what we can actually measure"

 Lord Darzi, High Quality Care for All, June 2008

Work package Leader: Lund University, Sweden
Duration:  M12 - M30 (19 months) has developed a set of Health Care Quality Indicators (HCQI) for Osteoarthritis (OA) and Rheumatoid arthritis (RA) which aim to measure and compare the quality of health service provision that should be available for people with these conditions across Europe. The HCQI will monitor optimal health care by taking into consideration health-system structures, processes and outcomes whilst focusing on patient centeredness, effectiveness and safety.

Patients suffering from rheumatic diseases have over the last decade seen a dramatic change in the modes of diagnosis and treatment. The new insights are reflected in numerous guidelines and recommendations for arthritis care which have been developed by international and national scientific societies and health care organizations in rheumatology during the last 10 years. However, unsatisfactory adherence to treatment guidelines and large variations in quality of care has been reported.

One way to quantify health care quality is by the use of validated health care quality indicators (HCQIs). These are intended to measure the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Unfortunately, the number of sets of HCQIs for Rheumatoid Arthritis (RA) and Osteoarthritis (OA) care has been relatively small. has further developed HCQIs which can be used to monitor the structures, processes and outcomes of health care for musculoskeletal conditions in European countries. established a working group, based in Lund, Sweden and led by Ingemar Peterson, Britta Strömbeck and Thea Vliet Vlieland (Associate Professor at Leiden University Medical Center); a second working group was established in Vienna Austria and led by Professor Joseph Smollen, Tanya Stamm and Michaela Stoffer.

The Austrian group developed user focused Standards of Care for both OA and RA, available for download here.

The Swedish-based working group then created a preliminary list of HCQI’s by referring to the Austrian developed SOC’s, These HCQI’s are designed to measure the impact and effectiveness of each standard of care.

All Health Care Quality Indicators needed to:

  • Make a difference
  • Be measurable
  • Be developed by representatives for health professionals and patients
  • Be generalizable to all member countries
  • Be open for use on different levels in the health care systems
  • Be easy to (use and) implement (feasible)
  • Be scientifically sound (face validity, content validity, reliability) and fit for international comparison.

For example if a standard of care states that “Weight reduction should be advised if necessary” the related health care quality indicator states: “The Percentage of overweight OA patients receiving advice on weight loss should be measured at least annually”.

The preliminary HCQI list was then refined by sixteen researchers and patient representatives from various European countries (Norway, Poland, Finland, Spain, Sweden, Italy, Danmark, the Netherlands and the United Kingdom) based on the following principles:

  • Existing guidelines set the standard
  • SOC states what the individual should expect in terms of care
  • HCQI states/measures what the provider should be delivering to the patient population
  • Health care indicators examine whether standards of care are being implemented
  • Quality Indicators are often more specific as compared to guideline recommendations:
  • Quality indicators describe exactly who should do what to whom and exactly when (van Hulst et al. 2009)

Potential inaccuracies or errors of the measure (often due to data source limitations) were identified. Issues related to the timing and frequency of data collection, patient confidentiality and other feasibility or implementation issues were noted. All this work resulted in the HCQI for OA and RA that are available as download on this website.

It is expected that the use of HCQI will raise awareness among individual rheumatologists and practices regarding gaps in their service. Governments and health care funders are increasingly beginning to reward clinicians for efficiency, quality and safety in health care, therefore measurable aspects of health care structures, processes and outcomes are needed. Also, the public release of data regarding individual rheumatologists´ or practices´ performance with respect to quality indicators may influence patients´ and referring physicians´ choices for specific specialists or practices.

The Swedish based working group is now working on the next phase of the development which is an audit tool that can be used across the Member States to measure the achievement of the agreed SOC and HCQI. This year a survey will be conducted using the audit tool within at least 4 Member States in order to pilot the SOC and HCQI. The aim is to set criteria to identify good practices and to create a check list including indicators and a range between which the measures of the indicators should fall.



Health Care Quality Indicators for RA and OA:



Audit tool to assess status of meeting Standards of Care and Health Care Quality Indicators:

Audit tool RA.pdf

Audit tool OA.pdf

Evaluation report of status of meeting the Standards of Care

Full report.pdf

Ingemar Peterson:

“Modern and equal care of high quality is crucial for all patients with rheumatoid arthrtitis and osteoarthritis. The Health Care Quality Indicators developed will be an important tool for patients and for the health care to provide this. “