Development of key performance indicators to evaluate centralized intake for patients with osteoarthritis and rheumatoid arthritis

Barber, Claire E.; Patel, Jatin N.; Woodhouse, Linda; Smith, Christopher; Weiss, Stephen; Homik, Joanne; LeClercq, Sharon; Mosher, Dianne; Christiansen, Tanya; Howden, Jane Squire; Wasylak, Tracy; Greenwood-Lee, James; Emrick, Andrea; Suter, Esther; Kathol, Barb; Khodyakov, Dmitry; Grant, Sean; Campbell-Scherer, Denise; Phillips, Leah; Hendricks, Jennifer; Marshall, Deborah A.

doi:10.1186/s13075-015-0843-7

Table 1 Key performance indicators for musculoskeletal centralized intake

From: Development of key performance indicators to evaluate centralized intake for patients with osteoarthritis and rheumatoid arthritis

Key performance indicator	Dimension of quality of care	Derived from existing measure	Included or removed after round 2
1. Time from osteoarthritis referral receipt to referral completion for initially incomplete referrals	Accessibility, efficiency	New KPI	Included
2. Time from rheumatoid arthritis referral receipt to referral completion for initially incomplete referrals	Accessibility, efficiency	New KPI	Included
3. Percentage of osteoarthritis referrals received with complete information	Efficiency	Hip and Knee Replacement Measurement Framework^a,b	Included
4. Percentage of rheumatoid arthritis referrals received with complete information	Efficiency	New KPI	Included
5. Time from receipt of complete osteoarthritis referral to musculoskeletal appointment	Accessibility	Hip and Knee Replacement Measurement Framework^a,b	Included
6. Waiting times for rheumatologist consultation for patients with new-onset rheumatoid arthritis	Accessibility	AAC Performance measures for IA^c	Included
7. Time to disease-modifying antirheumatic drug therapy for patients with new-onset rheumatoid arthritis	Accessibility, effectiveness	AAC Performance measures for IA^c	Included
8. Percentage of patients with new-onset rheumatoid arthritis with at least one visit to a rheumatologist in the first year of diagnosis	Accessibility	AAC Performance measures for IA^c	Included
9. Orthopaedic surgeons per 100,000 population	Accessibility	COA^d,e, AAOS^f, ACREU^e,g	Removed
10. Rheumatologists per 100,000 population	Accessibility	AAC Performance measures for IA^c	Included
11. Percentage of patients that receive information regarding resources and tools available for management while waiting for first musculoskeletal specialty contact	Appropriateness	Hip and Knee Replacement Measurement Framework^a,b	Included
12. Percentage of osteoarthritis referrals scored using Western Canada Waiting List priority referral criteria^h	Appropriateness	New KPI	Included
13. Distribution of osteoarthritis referrals in each urgency category (as scored using the Western Canada Waiting List referral tool)	Appropriateness	New KPI	Included
14. Percentage of osteoarthritis referrals triaged as highest urgency based on high Western Canada Waiting List priority criteria scores seen within Wait Time Alliance benchmarks	Appropriateness	New KPI	Included
15. Percentage of rheumatoid arthritis referrals assessed using a priority tool	Appropriateness	New KPI	Removed
16. Percentage of rheumatoid arthritis referrals categorized as early rheumatoid arthritis	Appropriateness	New KPI	Removed
17. Waiting times for patients with established rheumatoid arthritis	Accessibility	New KPI	Included
18. Percentage of rheumatoid arthritis patients treated with a disease-modifying antirheumatic drug during the measurement year	Effectiveness, accessibility	AAC Performance measures for IA^c	Included
19. Percentage of referrals rejected or redirected when received at centralized intake	Appropriateness	New KPI	Included
20. Percentage of musculoskeletal appointments completed as scheduled	Efficiency	Hip and Knee Replacement Measurement Framework^a,b	Included
21. Percentage of specialist providers participating in centralized intake	Efficiency	New KPI	Included
22. Number of referrals received through centralized intake	Efficiency	New KPI	Included
23. Patient experience with centralized intake	Acceptability	AHRQⁱ, NHS^j, and Ministry of Health and Long-Term Care (Ontario)^k	Included
24. Referring clinician experience with centralized intake	Acceptability	The Ministry of Health and Long-Term Care (Ontario)^k	Included
25. Musculoskeletal specialty care provider experience with centralized intake	Acceptability	The Ministry of Health and Long-Term Care (Ontario)^k	Included
26. Ratio of patient flow to estimated clinic capacity of osteoarthritis teams participating in centralized intake	Efficiency, accessibility	Developed during round 2	N/A
27. Operating room time for arthroplasty surgeons in Alberta	Accessibility	Developed during round 2	N/A
28. Ratio of patient flow to clinic capacity of rheumatoid arthritis teams participating in centralized intake	Efficiency, accessibility	Developed during round 2	N/A
29. Administrative staff and allied health professional experience with centralized intake	Acceptability	Developed during round 2	N/A
30. Agreement of centralized intake suspected diagnosis of severe osteoarthritis cases (e.g., patients who are candidates for hip or knee joint replacements) versus confirmed diagnosis of severe osteoarthritis	Appropriateness, effectiveness	Developed during round 2	N/A
31. Agreement of centralized intake suspected diagnosis versus confirmed diagnosis for rheumatoid arthritis	Appropriateness, effectiveness	Developed during round 2	N/A
		Total number of candidate KPIs before round 2: 25	Total number of candidate KPIs after round 2: 28

AAC Arthritis Alliance of Canada, IA Inflammatory Arthritis, AAOS American Academy of Orthopaedic Surgeons, ACREU Arthritis Community Research and Evaluation Unit, AHRQ Agency for Healthcare Research and Quality, COA, Canadian Orthopaedic Association, NHS, National Health Service
^aFrank et al. [27]
^bMarshall et al. [39]
^cBarber et al. [26]
^dRumble and Kreder [40]
^eBadley et al. [17]
^fNatividad [41]
^gCanizares et al. [42]
^hThe Western Canada Waiting List (WCWL) Project has developed and validated a hip and knee replacement priority criteria tool to assess clinical urgency for hip and knee joint replacements in a standardized and reliable manner [43]. The hip and knee replacement priority criteria tool is a clinician-scored tool consisting of seven items: (1) pain on motion, (2) pain at rest, (3) ability to walk, (4) other functional limitations, (5) abnormal findings, (6) potential for progression of disease and (7) ability to work, give care to dependents and live independently. The urgency is determined through a point count scoring system and could be used to structure and manage waiting lists for hip and knee joint replacements [44]
ⁱCamacho et al. [45]
^jClinical Indicators Team [46]
^kDeloitte & Touche LLP and affiliated entities [47]

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