Abstract
ObjectiveThe implementation of value‐based health care in inflammatory arthritis requires a standardized set of modifiable outcomes and risk‐adjustment variables that is feasible to implement worldwide.MethodsThe International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary working group that consisted of 24 experts from 6 continents, including 6 patient representatives, to develop a standard set of outcomes for inflammatory arthritis. The process followed a structured approach, using a modified Delphi process to reach consensus on the following decision areas: conditions covered by the set, outcome domains, outcome measures, and risk‐adjustment variables. Consensus in areas 2 to 4 were supported by systematic literature reviews and consultation of experts.ResultsThe ICHOM Inflammatory Arthritis Standard Set covers patients with rheumatoid arthritis (RA), axial spondyloarthritis, psoriatic arthritis, and juvenile idiopathic arthritis (JIA). We recommend that outcomes regarding pain, fatigue, activity limitations, overall physical and mental health impact, work/school/housework ability and productivity, disease activity, and serious adverse events be collected at least annually. Validated measures for patient‐reported outcomes were endorsed and linked to common reporting metrics. Age, sex at birth, education level, smoking status, comorbidities, time since diagnosis, and rheumatoid factor and anti‐citrullinated protein antibody lab testing for RA and JIA should be collected as risk‐adjustment variables.ConclusionWe present the ICHOM inflammatory arthritis Standard Set of outcomes, which enables health care providers to implement the value‐based health care framework and compare outcomes that are important to patients with inflammatory arthritis.
Highlights
The inflammatory arthritides are a group of systemic, immune-mediated rheumatic conditions, characterized by syno vitis or inflammation of periarticular tissues and joint damage
It was recognized by the working group that the same treatment goals and longitudinal outcomes are relevant to most types of inflammatory arthritis
The inclusion of gout (59% voted to include initially), connective tissue diseases (41%) and vasculitis (36%) was considered, especially as few outcome recommendations are available for the latter 2 conditions. After revisiting this topic at a subsequent meeting, it was decided that their inclusion might lead to a generic set of outcomes, which might insufficiently capture the outcomes that matter to patients with individual conditions, due to the variety of disease manifestations and disease courses
Summary
The inflammatory arthritides are a group of systemic, immune-mediated rheumatic conditions, characterized by syno vitis or inflammation of periarticular tissues and joint damage. The availability of strategies to diagnose the diseases earlier, and the availability of biologic and targeted small molecule therapies, in combination with early, tightly controlled treatment strategies have led to relevant improvements in outcomes for many patients over the last decades [2,3] These improvements have resulted in an increased financial burden on health care systems [4,5]. Dr Mease has received consulting fees, speaking fees, and/or honoraria from Bristol-Myers Squibb, UCB, Celegne, Genentech, SUN, Corrona (less than $10,000 each), AbbVie, Amgen, Janssen, Eli Lilly, Novartis, and Pfizer (more than $10,000 each) and research support from Bristol-Myers Squibb, UCB, Corrona, Abbvie, Amgen, Janssen, Novartis, and Pfizer. Public reporting of patient outcomes by health care providers is proposed as a mechanism that will accelerate identification and adoption of high value care, through shared learning and promoting benchmarking of outcomes that matter to patients
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