Quality of osteoarthritis care for community-dwelling older adults

Objective. To describe the quality of osteoarthritis care provided to community-dwelling elderly patients and to characterize arthritis-related function in these patients. Methods. Two medical groups in the western United States participated in a practice-redesign intervention targeted at falls and mobility disorders, incontinence, and cognitive impairment, but not osteoarthritis. From 339 individuals reporting a diagnosis of arthritis, we collected information on demographics, functional status, and quality of care via patient interviews and mailed questionnaires. Eight quality indicators measured osteoarthritis care: 4 indicators measuring the provision of effective osteoarthritis care (osteoarthritis treatment indicators) and 4 measuring the provision of safe osteoarthritis care (medication safety indicators). Results. The mean +/- SD Short Form 12 physical component summary score was 35 +/- 11 points, indicating a physically frail population. The overall indicator pass rate was 57.0% (95% confidence interval [95% CI] 53.9-60.2). Pass rates were higher for indicators of osteoarthritis treatment (63.5%, 95% CI 59.8-67.2) than for indicators of medication safety (43.8%, 95% CI 38.2-49.4). Patients with hip or knee pain had mean +/- SD Western Ontario and McMaster Universities Osteoarthritis Index pain, stiffness, and function scores of 6.0 +/- 4.0, 3.1 +/- 1.7, and 25 +/- 12 points, respectively. Conclusion. Quality of osteoarthritis care for older adults is suboptimal, particularly with regard to medication safety. Given the high prevalence of osteoarthritis in older age groups, the population impact of any improvement in quality would be substantial. Quality improvement efforts for osteoarthritis should target appropriate use of and counseling regarding medications, as well as underuse of efficacious therapy for osteoarthritis.