{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:42:58Z","timestamp":1790444578706,"version":"4.1.0"},"reference-count":34,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T00:00:00Z","timestamp":1601337600000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Italian Society for Rheumatology","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,8,12]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the adherence to quality of care indicators in early rheumatoid arthritis (RA) and to evaluate its impact on the risk of hospitalisation in a real-world setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Patients with early-onset RA identified from healthcare regional administrative databases by means of a validated algorithm between 2006 and 2012 in the Lombardy region (Italy).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The study cohort included 14\u2009203 early-onset RA (71% female, mean age 60 years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>For each patient, a summary adherence score was calculated starting from the compliance to six quality indicators: (1\u20132) methotrexate or sulfasalazine or leflunomide with\/without glucocorticoids, (3\u20134) other disease-modifying antirheumatic drugs (DMARDs) with\/without glucocorticoids, (5) early interruption of glucocorticoids, (6) early clinical assessment.<\/jats:p>\n                    <jats:p>The relationship between low, intermediate and high categories of the summary score and the 12-month risk of hospitalisation for all causes and for RA was assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a follow-up of 1 year, 2609 hospitalisations occurred, of which 704 were for RA (main or secondary diagnosis) and 252 primarily for RA. In a 7-year period (2006\u20132012), early DMARDs and timely clinical monitoring treatment increased (from 52% to 62% p trend &lt;0.001\u2009and from 25% to 30% p trend 0.009, respectively).<\/jats:p>\n                    <jats:p>Intermediate and high summary adherence score categories (compared with the low category) were related significantly with a lower risk of hospitalisation (adjusted HR 0.85 (95% CI 0.77 to 0.93),\u2009p&lt;0.001\u2009and HR 0.76 (95% CI 0.69 to 0.84),\u2009p&lt;0.001, respectively). Among the indicators of the adherence score, early DMARD prescription showed the strongest positive impact, while long-term use of glucocorticoids was the worst negative one.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In early RA, adherence to quality standards of care is associated with a lower risk of hospitalisation. Future interventions to improve the adherence to quality standards of care in this setting should decrease the risk of hospitalisation with a significant impact on individual and population health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-038295","type":"journal-article","created":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T17:38:51Z","timestamp":1601401131000},"page":"e038295","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology"],"prefix":"10.1136","volume":"10","author":[{"given":"Anna","family":"Zanetti","sequence":"first","affiliation":[{"name":"Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy"},{"name":"Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Lombardy, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7451-0271","authenticated-orcid":false,"given":"Carlo Alberto","family":"Scir\u00e8","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Argnani","sequence":"additional","affiliation":[{"name":"Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Emilia-Romagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Carrara","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Zambon","sequence":"additional","affiliation":[{"name":"Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Lombardy, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,29]]},"reference":[{"key":"2026062608035949000_10.9.e038295.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(01)00872-5"},{"key":"2026062608035949000_10.9.e038295.2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keh199"},{"key":"2026062608035949000_10.9.e038295.3","doi-asserted-by":"publisher","DOI":"10.1002\/art.22353"},{"key":"2026062608035949000_10.9.e038295.4","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20453"},{"key":"2026062608035949000_10.9.e038295.5","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.semarthrit.2019.02.004","article-title":"Risk profiling for a refractory course of rheumatoid arthritis","volume":"49","author":"B\u00e9c\u00e8de","year":"2019","journal-title":"Semin Arthritis Rheum"},{"key":"2026062608035949000_10.9.e038295.6","first-page":"1072","article-title":"Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well","volume":"25","author":"Symmons","year":"1998","journal-title":"J Rheumatol"},{"key":"2026062608035949000_10.9.e038295.7","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-203339"},{"key":"2026062608035949000_10.9.e038295.8","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.056390"},{"key":"2026062608035949000_10.9.e038295.9","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210715"},{"key":"2026062608035949000_10.9.e038295.10","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-203765"},{"key":"2026062608035949000_10.9.e038295.11","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.150839"},{"key":"2026062608035949000_10.9.e038295.12","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/j.berh.2015.09.009","article-title":"Quality in rheumatoid arthritis care","volume":"29","author":"Mahmood","year":"2015","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2026062608035949000_10.9.e038295.13","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.semarthrit.2017.02.009","article-title":"Standards of care for inflammatory arthritis: a literature review","volume":"47","author":"Wilson","year":"2017","journal-title":"Semin Arthritis Rheum"},{"key":"2026062608035949000_10.9.e038295.14","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1007\/s00296-013-2741-0","article-title":"Quality-Of-Care standards for early arthritis clinics","volume":"33","author":"Ivorra","year":"2013","journal-title":"Rheumatol Int"},{"key":"2026062608035949000_10.9.e038295.15","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1002\/acr.22910","article-title":"Patterns of care among patients referred to rheumatologists in Ontario, Canada","volume":"69","author":"Widdifield","year":"2017","journal-title":"Arthritis Care Res"},{"key":"2026062608035949000_10.9.e038295.16","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1089\/pop.2015.0133","article-title":"Assessment of rheumatoid arthritis quality process measures and associated costs","volume":"20","author":"Brady","year":"2017","journal-title":"Popul Health Manag"},{"key":"2026062608035949000_10.9.e038295.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0171070","article-title":"Does non-adherence to DMARDs influence hospital-related healthcare costs for early arthritis in the first year of treatment?","volume":"12","author":"Pasma","year":"2017","journal-title":"PLoS One"},{"key":"2026062608035949000_10.9.e038295.18","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-017-10558-w","article-title":"Development and validation of a multivariate predictive model for rheumatoid arthritis mortality using a machine learning approach","volume":"7","author":"Lezcano-Valverde","year":"2017","journal-title":"Sci Rep"},{"key":"2026062608035949000_10.9.e038295.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006029"},{"key":"2026062608035949000_10.9.e038295.20","first-page":"60","article-title":"Risk of hospitalisation for serious bacterial infections in patients with rheumatoid arthritis treated with biologics. analysis from the record linkage on rheumatic disease study of the Italian Society for rheumatology","volume":"37","author":"Carrara","year":"2019","journal-title":"Clin Exp Rheumatol"},{"key":"2026062608035949000_10.9.e038295.21","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00296-018-4196-9","article-title":"Risk of hospitalization for heart failure in rheumatoid arthritis patients treated with etanercept and abatacept","volume":"39","author":"Generali","year":"2019","journal-title":"Rheumatol Int"},{"key":"2026062608035949000_10.9.e038295.22","first-page":"310","article-title":"Comparison of the risks of hospitalisation for cardiovascular events in patients with rheumatoid arthritis treated with tocilizumab and etanercept","volume":"36","author":"Generali","year":"2018","journal-title":"Clin Exp Rheumatol"},{"key":"2026062608035949000_10.9.e038295.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-021447"},{"key":"2026062608035949000_10.9.e038295.24","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2017-000523"},{"key":"2026062608035949000_10.9.e038295.25","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jclinepi.2019.08.009","article-title":"A new population-based risk stratification tool was developed and validated for predicting mortality, hospital admissions, and health care costs","volume":"116","author":"Rea","year":"2019","journal-title":"J Clin Epidemiol"},{"key":"2026062608035949000_10.9.e038295.26","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90133-8"},{"key":"2026062608035949000_10.9.e038295.27","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1007\/s40261-018-0642-4","article-title":"Adherence to antidepressants and mortality in elderly patients with cardiovascular disease","volume":"38","author":"Biffi","year":"2018","journal-title":"Clin Drug Investig"},{"key":"2026062608035949000_10.9.e038295.28","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jclinepi.2016.03.031","article-title":"Regression coefficient-based scoring system should be used to assign weights to the risk index","volume":"79","author":"Mehta","year":"2016","journal-title":"J Clin Epidemiol"},{"key":"2026062608035949000_10.9.e038295.29","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/69.1.239"},{"key":"2026062608035949000_10.9.e038295.30","doi-asserted-by":"publisher","DOI":"10.1002\/art.11439"},{"key":"2026062608035949000_10.9.e038295.31","first-page":"1033","article-title":"Direct and indirect healthcare costs of rheumatoid arthritis patients in Turkey","volume":"34","author":"Hamuryudan","year":"2016","journal-title":"Clin Exp Rheumatol"},{"key":"2026062608035949000_10.9.e038295.32","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1007\/s10067-019-04515-3","article-title":"Early arthritis clinic is cost-effective, improves outcomes and reduces biologic use","volume":"38","author":"Nisar","year":"2019","journal-title":"Clin Rheumatol"},{"key":"2026062608035949000_10.9.e038295.33","doi-asserted-by":"publisher","DOI":"10.1002\/art.10092"},{"key":"2026062608035949000_10.9.e038295.34","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-214618"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-038295","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:19:06Z","timestamp":1782487146000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-038295"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9,29]]},"published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1136\/bmjopen-2020-038295"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-038295","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9]]}}}