Scleroderma

Despite the increasing awareness of Scleroderma (SSc), it continues to have a detrimental effect of the quality of health and lives of those with it. The medical community has recognized that although early treatment of Scleroderma can have a substantial effect on outcomes, no studies of the quality of care had been done.

Similarly, Quality Indicators (QI) had already been established for health care in arthritis, gout, rheumatologic prescribing, and systemic lupus erythematosus - but none for the treatment of Scleroderma (SSc). Earlier this year, a set of quality indicators for Scleroderma were published by some of the top Scleroderma researchers. These indicators were meant to represent measurable, minimum standards of care that should be applied to all patients with Scleroderma.

These researchers chose to develop these measures because the processes of care tended to be under the control of the health care provider or health system and are more efficiently measured than the outcomes. Additionally, it would have allowed for the identification of specific areas of care that were deficient and could have been targeted for quality improvement.

The Indicators covers nine essential areas: Cardiopulmonary, Pulmonary, Gastrointestinal,  Renal, Musculoskeletal, Cutaneous, Health-Related Quality of Life, Serologies, and Prevention and Drug Monitoring. 32 Quality Indicators were developed: 9 for those newly diagnosed with Scleroderma, 12 follow-up indicators for its management, and 11 for treatment. A few were highlighted below;

• General: IF a patient has newly diagnosed systemic sclerosis, THEN anti-topoisomerase I, anti-centromere, and anti-RNA-polymerase III antibody tests should be offered within 12 months of diagnosis BECAUSE these tests can help determine prognosis.
• Cardio-Pulmonary: IF a patient has newly diagnosed systemic sclerosis, THEN a resting echocardiogram with Doppler should be offered within 12 months of diagnosis BECAUSE this screens for pulmonary arterial hypertension, diastolic dysfunction, pericardial effusion, and cardiomyopathy.
• Physical Function: IF a patient has newly diagnosed systemic sclerosis, THEN the medical record should document a measure of functional status (e.g. activities of daily living, health assessment questionnaire-disability index or self-report) within 12 months of diagnosis BECAUSE scores on these measures predict morbidity and mortality associated with SSc.
• Renal: IF a patient has newly diagnosed has systemic sclerosis, THEN a serum creatinine should be offered within 6 months of diagnosis BECAUSE it can help define the presence and degree of renal involvement by systemic sclerosis.
• Treatment, General: IF a patient has systemic sclerosis, THEN annual inactive influenza vaccine should be offered unless contraindications are documented, BECAUSE this can prevent or decrease the severity of influenza infection.
• Treatment, Musculoskeletal: IF a patient has early systemic sclerosis (<5 years from first signs or symptoms) and presents with decreased range of motion or function of the hands, THEN a range of motion exercise program should be offered within six months BECAUSE it may improve hand joint range of motion or hand function.
• Peripheral Vascular: IF a patient with systemic sclerosis has digital tip ulcer(s), THEN treatment (e.g. calcium channel blockers, prostacyclin therapy, topical nitrate therapy, PDE-5 inhibitor) should be prescribed within 3 months of diagnosis BECAUSE treatment improves healing of digital ulcers and hand function.

To read the full article from Clinical and Experimental Rheumatology, we would like to encourage you to visit the following link. You can also read the previous article we posted earlier this year. We encourage you to also print out a copy for reference and to share with your medical practitioner or doctor.