Quality standards for the care of people with giant cell arteritis in secondary care

Coath, F.L. and Bukhari, M. and Ducker, G. and Griffiths, B. and Hamdulay, S. and Hingorani, M. and Horsburgh, C. and Jones, C. and Lanyon, P. and MacKie, S. and Mollan, S. and Mooney, J. and Nair, J. and Patil, A. and Robson, J. and Saravanan, V. and O'Sullivan, E.P. and Whitlock, M. and Mukhtyar, C.B. (2023) Quality standards for the care of people with giant cell arteritis in secondary care. Rheumatology, 62 (9). pp. 3075-3083. ISSN 1462-0324

Abstract

Objective: GCA is the commonest primary systemic vasculitis in adults, with significant health economic costs and societal burden. There is wide variation in access to secondary care GCA services, with 34% of hospitals in England not having any formal clinical pathway. Quality standards provide levers for change to improve services. Methods: The multidisciplinary steering committee were asked to anonymously put forward up to five aspects of service essential for best practice. Responses were qualitatively analysed to identify common themes, subsequently condensed into domain headings, and ranked in order of importance. Quality standards and metrics for each domain were drafted, requiring a minimum 75% agreement. Results: 13 themes were identified from the initial suggestions. Nine quality standards with auditable metrics were developed from the top 10 themes. Patient Access, glucocorticoid use, pathways, ultrasonography, temporal artery biopsy, PET scan access, rheumatology/ophthalmology expertise, education, multidisciplinary working have all been covered in these quality standards. Access to care is a strand that has run through each of the developed standards. An audit tool was developed as part of this exercise. Conclusion: These are the first consensus auditable quality standards developed by clinicians from rheumatology and ophthalmology, nursing representatives and involvement of a patient charity. We hope that these standards will be adopted by commissioning bodies to provide levers for change from the improvement of patient care of individuals with GCA.