Table 5
Workforce prediction risk of bias tool*
| Factor | Risk of bias |
| General factors | |
| Type of model |
 High: model was only based on demand or need or supply factors Moderate: integrated model that considered demand, need and supply with supply=demand at baseline Low: integrated model that considered demand, need and supply with supply≠demand at baseline |
| Time horizon |
 High: predictions >30 years Moderate: predictions <5 or between 16 and 30 years Low: predictions between 5 and 15 years |
| Update of the model |
 High: no update was performed Moderate: any kind of update was performed, but not within 1–4 years’ interval Low: frequent updates were performed (1–4 years’ interval) |
| Assessment of model performance |
 High: no assessment was done Moderate: one kind of quality assessment was done to ensure the rigour and accuracy of the model Low: more than one assessment was done |
| Uncertainty analyses |
 High: no uncertainty analysis was performed Moderate: one or two uncertainty analyses were performed, without clear justification of the choice Low: more than two uncertainty analyses were performed, choices and analyses well justified |
| Regional heterogeneity |
 High: regional heterogeneity was not considered Moderate: calculations were performed on national level but anticipated regional discrepancies are discussed Low: calculations took into account relevant regional profile of the country |
| Stakeholder involvement |
 High: stakeholders were not involved in the workforce prediction Moderate: one group of stakeholders was involved in the workforce prediction Low: more than one group of stakeholders was involved in the workforce prediction |
| Demand/need factors | |
| Scope of diseases covered by rheumatology specialty |
 High: either not listed or not deemed representative (eg, insufficient number of disease groups, unjustified author’s estimate etc) Moderate: stated but the probability that they are representative is limited Low: stated and the probability that they are representative is high |
| Disease definition |
 High: not stated Moderate: unclear criteria, self-reported diagnoses or ICD codes from the registry (single or multiple data sources) or criteria stated, relying on physician-reported diagnoses using single source of data
Low: criteria stated, relying on physician-reported diagnoses and using more than one source, including at least data from population based database |
| No and length of visits/year per patient |
 High: not considered Moderate: considered, but separate estimations done for at least one aspect Low: considered, including separate estimation for more than two aspects (type of disease, disease phase, type of visit) |
| % patients referred to rheumatologist |
 High: not considered Moderate: considered without distinguishing between diseases Low: considered, including separate estimation per disease group |
| Projection of population development |
 High: not considered or only size of population is included Moderate: age or/and sex structure and/or other factors included but using single data source Low: age or/and sex structure and/or other factors included using more than one source and relying on statistics or national population projections |
| Projection of epidemiology of diseases |
 High: not considered Moderate: one or multiple factors influencing epidemiology (incidence/prevalence) considered but using single source of data Low: more than two factors considered, using more than one data source |
| Effect of medical development |
 High: effects of medical development not considered Moderate: effects of medical development considered based on author’s estimates Low: effects of medical development considered based on formal data or expert consensus |
| National economic development |
 High: not considered Moderate: one economic factor influencing economic development (eg, per capita income) consideredLow: more than one economic factor considered |
| Supply-based factors | |
| Clinical setting |
 High: not considered in calculation Moderate: one type of settings considered in the calculation Low: more than one type of settings considered in the calculation |
| Time spent on clinical (rheumatologic) care |
 High: not considered in calculation of supply Moderate: % of time dedicated to clinical duties defined without detailed estimation of number, duration, and type of visit (single or multiple data sources) or
% of time dedicated to clinical duties calculated through estimating the number, duration and type of visits, but using single data source  Low: % of time dedicated to clinical duties calculated through estimating the number, duration and type of visits, using more than one data source |
| Tasks delegated to other health professionals in rheumatology (HP) |
 High: involvement of other HP in care for rheumatological patients not considered Moderate: involvement of other HP considered based on author’s estimates Low: involvement of other HP considered in the workforce calculation based on data or formal expert consensus |
| Demographic trends in workforce |
 High: not considered Moderate: one demographic trend (eg, ageing, feminisation, millennial trend) considered Low: more than one demographic trends considered |
| Entry and exit to profession (not related to demographic changes of workflow) |
 High: not considered Moderate: one or multiple entry and exit factors considered but using single data source Low: more than one entry and exit factors considered, using more than one source |
| Result presented in number of rheumatologists and/or clinical full-time equivalents (FTEs) |
 High: projections only presented in necessary clinical FTEs without possibility to recalculate in number of persons Moderate: projections only presented in number of rheumatologists without possibility to recalculate in FTEs Low: both projected number of rheumatologists and FTE per population |
*Complete version of the tool together with further details and rationale can be found in online supplementary table S7.