The Development of Rheumatoid Arthritis‐Specific Ambulatory Care Sensitive Conditions: Results of a Consensus Process
Kara Irwin, Candace H. Feldman, Claire E.H. Barber, Gabriel Fabreau, Jake Jennings, Scott Patten, Cheryl Barnabe,Objective
Ambulatory care sensitive conditions (ACSCs) serve as indicators of access, quality, and performance of the health system. This study aimed to determine rheumatoid arthritis (RA)‐specific ACSCs for use in the evaluation of care system access and quality.
Methods
A modified Delphi process was conducted on the preventability and importance of hospitalization for candidate medical conditions determined from a systematic literature review. Clinical panelists included healthcare providers with expertise in the care of persons with RA. Patient panelists were persons living with RA. Clinical panelists completed 2 rounds of anonymous voting, with an asynchronous discussion board hosted between rounds. Patient panelists completed the same process considering the remaining conditions where consensus had not yet been reached. An interactive webinar preceded a final combined panel voting round. Consensus criteria were guided by the RAND/UCLA Appropriateness Method.
Results
Twenty‐two clinical and 8 patient panelists provided their expert opinion on 49 candidate conditions. At the conclusion of all voting rounds, 13 conditions were identified as proposed RA‐specific ACSCs: those specific to RA disease activity (RA disease flare, vasculitis), RA‐related associations and complications (anemia/pancytopenia, osteoporotic fracture, secondary osteoarthritis, cervical spine instability), as well as acute (upper respiratory infection, influenza/pneumonia, septic arthritis) and opportunistic infections (herpes zoster, tuberculosis reactivation, pneumocystis jirovecii pneumonia, and other).
Conclusion
Consensus was achieved for 13 proposed RA‐specific ACSCs that could be used to monitor care access and quality for persons living with RA, determine population‐level differences, and appropriately allocate resources. Next steps include operationalizing and testing performance of RA‐specific ACSCs.