Development of American College of Rheumatology Quality Measures for Systemic Lupus Erythematosus: A Modified Delphi Process with RISE Registry Data Review.

OBJECTIVE: We aimed to develop readily measurable digital quality measure statements for clinical care in systemic lupus erythematosus (SLE) using a multi-step process guided by consensus methods.

METHODS: Using a modified Delphi process, an American College of Rheumatology (ACR) workgroup of SLE experts reviewed all North American and European guidelines from 2000-2020 on treatment, monitoring, and phenotyping of patients with lupus. Workgroup members extracted quality constructs from guidelines, rated these by importance and feasibility, and generated evidence-based quality measure statements. The ACR Rheumatology Informatics System for Effectiveness (RISE) registry was queried for measurement data availability. In three consecutive Delphi sessions, a multidisciplinary Delphi panel voted on importance and feasibility of each statement. Proposed measures with consensus on feasibility and importance were ranked to identify the top three measures.

RESULTS: Review of guidelines and distillation of 57 quality constructs resulted in 15 quality measure statements. Among these, five met high consensus for importance and feasibility, including two on treatment and three laboratory monitoring measures. The three highest-ranked statements were recommended for further measure specification as SLE digital quality measures: 1) hydroxychloroquine use, 2) limiting glucocorticoid use >7.5 mg/day to <6 months, and 3) end-organ monitoring of kidney function and urine protein excretion at least every 6 months.

CONCLUSION: The Delphi process selected three quality measures for SLE care on hydroxychloroquine, glucocorticoid reduction and kidney monitoring. Next, measures will undergo specification and validity testing in RISE and US rheumatology practices as the foundation for national implementation and use in quality improvement programs. This article is protected by copyright. All rights reserved.