Understanding the impact 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 impact 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 four matched cohorts where PMs were met vs not met. PMs included access to rheumatology care, retention in care, early DMARD use, and ongoing DMARD therapy. Results Among 19,765 individuals with RA, 44.78% had access to a rheumatologist within one year of diagnosis; 24.91% were retained in care, while 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 impact on risk of TJR at 10-years in our propensity-matched analysis for three of the PMs, while a slightly elevated risk (HR 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 measures with a greater impact on patient outcomes.