Opinion of Japanese rheumatology physicians on methods of assessing the quality of rheumatoid arthritis care

Abstract

To examine the opinion of rheumatology physicians in Japan regarding desirable quality assessment methods. We conducted a cross-sectional self-administered mail survey on a random sample of physicians and surgeons registered with the Japan Rheumatism Foundation. In the survey, respondents were asked to rank seven proposed assessment methods for the quality of rheumatoid arthritis care, namely patient satisfaction, risk-adjusted outcomes such as complication incidence and admission rate, guideline compliance, waiting time at clinics, voting by local general practitioners, degree of newspaper and magazine reportage, and volume of patients receiving treatment for rheumatoid arthritis. Among 531 respondents (response rate 48%), the respondents ranked patient satisfaction most favourably (mean rank 1.6), followed by complication/admission rate and number of patients. Guideline adherence was ranked almost the same as voting by local physicians. Waiting time and media reportage were not considered good methods for quality evaluation. Ranking distribution did not differ by working facility or place, volume of patients or years in practice. Multivariate analysis revealed that respondents who care for a large number of rheumatoid arthritis patients (>40 regular patients) were less likely to rank guideline adherence highly (first to third) than those who care for few patients (≤ 10 regular patients), with an odds ratio of 0.38 (P < 0.01) after adjustment for other variables. A majority of Japanese rheumatology physicians consider patient satisfaction the most trustworthy method of assessing the quality of rheumatoid arthritis care. Future research should explore convincing methods of assessing the technical quality of rheumatoid arthritis care.