Arthritis care & research · 2026
The Development of Rheumatoid Arthritis-Specific Ambulatory Care-Sensitive Conditions: Results of a Consensus Process.
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Irwin Kara, Feldman Candace H, Barber Claire E H, Fabreau Gabriel, Jennings Jake, Patten Scott, Barnabe Cheryl, Inflammatory Arthritis‐Specific ACSC Consensus Process Working Group
Аннотация
OBJECTIVE: Ambulatory care-sensitive conditions (ACSCs) serve as indicators of access, quality, and performance of the health system. This study aimed to determine rheumatoid arthritis (RA)-specific ACSCs for use in the evaluation of care system access and quality.
METHODS: A modified Delphi process was conducted on the preventability and importance of hospitalization for candidate medical conditions determined from a systematic literature review. Clinical panelists included health care providers with expertise in the care of people with RA. Patient panelists were people living with RA. Clinical panelists completed two rounds of anonymous voting, with an asynchronous discussion board hosted between rounds. Patient panelists completed the same process considering the remaining conditions for which consensus had not yet been reached. An interactive webinar preceded a final combined panel voting round. Consensus criteria were guided by the RAND/UCLA Appropriateness Method.
RESULTS: A total of 22 clinical and 8 patient panelists provided their expert opinion on 49 candidate conditions. At the conclusion of all voting rounds, 13 conditions were identified as proposed RA-specific ACSCs: those specific to RA disease activity (RA disease flare, vasculitis), RA-related associations and complications (anemia/pancytopenia, osteoporotic fracture, secondary osteoarthritis, cervical spine instability), and acute (upper respiratory infection, influenza/pneumonia, septic arthritis) and opportunistic infections (herpes zoster, tuberculosis reactivation, Pneumocystis jirovecii pneumonia, and other).
CONCLUSION: Consensus was achieved for 13 proposed RA-specific ACSCs that could be used to monitor care access and quality for persons living with RA, determine population-level differences, and appropriately allocate resources. Next steps include operationalizing and testing performance of RA-specific ACSCs.
METHODS: A modified Delphi process was conducted on the preventability and importance of hospitalization for candidate medical conditions determined from a systematic literature review. Clinical panelists included health care providers with expertise in the care of people with RA. Patient panelists were people living with RA. Clinical panelists completed two rounds of anonymous voting, with an asynchronous discussion board hosted between rounds. Patient panelists completed the same process considering the remaining conditions for which consensus had not yet been reached. An interactive webinar preceded a final combined panel voting round. Consensus criteria were guided by the RAND/UCLA Appropriateness Method.
RESULTS: A total of 22 clinical and 8 patient panelists provided their expert opinion on 49 candidate conditions. At the conclusion of all voting rounds, 13 conditions were identified as proposed RA-specific ACSCs: those specific to RA disease activity (RA disease flare, vasculitis), RA-related associations and complications (anemia/pancytopenia, osteoporotic fracture, secondary osteoarthritis, cervical spine instability), and acute (upper respiratory infection, influenza/pneumonia, septic arthritis) and opportunistic infections (herpes zoster, tuberculosis reactivation, Pneumocystis jirovecii pneumonia, and other).
CONCLUSION: Consensus was achieved for 13 proposed RA-specific ACSCs that could be used to monitor care access and quality for persons living with RA, determine population-level differences, and appropriately allocate resources. Next steps include operationalizing and testing performance of RA-specific ACSCs.