Asistance quality standards in rheumatology

Objective: To developed standards for quality of care and processing times in rheumatology. Materials and methods: After a systematic review of the literature, a working group of 10 rheumatologists and 2 methodologists selected 164 indicators of quality of care and processing times. A panel of 65 experts rated the indicators following a Delphi methodology. Results: Among the most important of the 164 standards obtained were: maximum number of inhabitants per rheumatologist (40,000-50,000);minimum number of rheumatologists in a Rheumatology Unit (3); duration of the first visit (30 minutes) and successive visits (19 minutes), ratio of successive/first visits (3.2); a rheumatologist should receive no more than 5 first visits/day and no more than 11 successive visits/day, and should spend no more than 5 hours on patients visits/ day nor more than 4 days/week; the maximum waiting time for first visits should not exceed 4 weeks; the time needed to visit hospitalised patients (43 minutes on admission, 17 minutes for daily visit and 40 minutes at discharge); and time to carry out some of the most frequent procedures in rheumatology (12 minutes for arthrocentesis and infiltrations and 17 minutes for synovial fluid analysis). Conclusions: This study establishes basic standards for quality of care, organisation and process times. It is a useful tool for organizing a Rheumatology Unit which can facilitate dialogue with health administrators and help improve the quality of rheumatology care.