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Background: Gout is the most prevalent inflammatory arthritis, yet it remains undertreated despite affordable and effective treatment options. High quality data evaluating current gout management and risk factors for poor management are lacking, especially outside specialized rheumatology setting. Objectives: To develop electronic quality criteria based on existing guidelines and apply them automatically to an electronic health record(EHR)-based gout register of in- and outpatients. Methods: Based on the 2020 American College of Rheumatology, 2016 EULAR guidelines for gout management, and 2018 EULAR recommendations for gout diagnosis, we selected all grade A recommendations according to the Grading of Recommendations, Assessment, Development, and Evaluations framework. When recommendations contained several subsections, they were further split in individual statements. We then assessed the recommendations for feasibility of implementation in an EHR-based gout register from the Geneva university hospital, containing 5'138 patients as of 31.12.2022 depending on available data and show results for two criteria. Results: The 3 sets of guidelines contained 61 recommendations corresponding to 87 statements associated to a grading of evidence (Figure 1). Of the 27 statements with grade A evidence, 4 were excluded because of redundancy with other criteria, and 10 because of non-extractible data. Three statements concerned patients' education (i.e. use of urate lowering therapy or self-medication), 2 dealt with physicians' assessment of patients' comorbidities, 2 were about imaging recommendation for unconfirmed gout, 1 each pertained to drug selection, asymptomatic hyperuricaemia and criteria lacking a specific target. Of the remaining 13 criteria deemed feasible (Table 1) according to available data, 6 were related to acute flare treatment, 3 to urate-lowering therapy indication (ULT), 3 to recommendations for patient under ULT and 1 to diagnostic. The criteria concerning indication for ULT in patient with recurrent flares (i.e. at least two flares during one year, n=163) showed a prescription of an ULT in 66.9% of the patients within a year, in patients that visited the hospital again. Among patients with documented tophi (n=72), 20.8% of patients did not receive an ULT within a year. Regarding diagnostic criteria, 44.9% of patients received a plain radiography of the articulation within 10 days of an acute gout flare proven by a joint aspiration (n=965) to look for imaging evidence of gout complications (tophus, erosions), which, if detected, may prompt the consideration and potential early initiation of urate-lowering therapy to manage and prevent further complications. Conclusion: We describe the process of creating electronic quality criteria from existing guidelines on gout management and diagnosis. Through two illustrative examples, our study highlights the evident margins for improvement in gout care, underscoring the need for enhanced therapeutic strategies and patient management approaches in this domain. These criteria, applied automatically to an existing EHR-based gout register, will serve as quality indicator of adequate gout management, and allow their monitoring in time following improvement projects, or change in policies. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared. Table 1. 13 grade A statements selected to be used as electronic quality criteria in an electronic health record-based gout register. Source 1: 2016 EULAR guidelines for gout management. 2: 2020 American College of Rheumatology for gout management. 3: 2018 EULAR recommendations for gout diagnosis.
Bürgisser et al. (Sat,) studied this question.