A national survey of Veterans Affairs Rheumatologists for relevance of quality of care indicators for Gout management

Abstract

To determine the relevance of current gout quality indicators (QIs). Members of the Veterans Affairs (VA) Rheumatology Consortium were invited to participate in an online survey and provide opinions (rank 0-10) regarding existing gout QIs. Opinions sought on each QI were 1) relevance to US veterans, 2) likelihood to improve gout care, and 3) ease of electronic capture. Participants were also asked to rank their top 3 gout QIs. Participating VA rheumatologists were mainly men, with a mean age of 51.3 years, and experienced in the management of gout. All 10 gout QIs were considered relevant, with a score of 8.2 or higher. The initiation of urate-lowering therapy, monitoring of urate levels after initiation of urate-lowering therapy, and treatment of acute gout with antiinflammatory agents scored the highest with regard to likelihood of improving gout care, with the first 2 QIs also thought to be the most relevant. Adjustment of initial allopurinol dosing in patients with renal impairment and in those receiving concurrent azathioprine/6-mercaptopurine were perceived as the QIs most amenable to electronic capture. The top-ranked QIs were initiation of urate-lowering therapy with frequent gout attacks, serum urate monitoring after initiation of urate-lowering therapy, and adjustment of initial allopurinol dose to renal function. In a national survey of VA rheumatologists, most gout QIs were thought to be highly relevant. QIs related to initiation of urate-lowering therapy, serum urate monitoring, and initial dosing of allopurinol were ranked the most important for veterans with gout.