Quality of Care in Systemic Lupus Erythematosus: Application of Quality Measures to Understand Gaps in Care
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Systemic lupus erythematosus (SLE) affects 1 in 2500 Americans and is associated with significant morbidity and mortality. The recent development of SLE quality measures provides an opportunity to understand gaps in clinical care and to identify modifiable factors associated with variations in quality.
To evaluate performance on SLE quality measures as well as differences in quality of care by demographic, socioeconomic, disease, and health system characteristics.
DESIGN AND PATIENTS
Cross-sectional analysis of data derived from the Lupus Outcomes Study, a prospective, longitudinal study of 814 individuals. Principal data collection was through annual structured telephone surveys between 2009–2010. Data on 13 SLE quality measures was collected. We used regression models to estimate demographic, socioeconomic, disease, and health system characteristics associated with performance on individual and overall quality measures.
Performance on each quality measure and overall performance on all measures for which participants were eligible (pass rate).
Participants were eligible for a mean of five measures (range 2–12). Performance varied from 29 % (assessment of cardiovascular risk factors) to 90 % (sun avoidance counseling). The overall pass rate was 65 % (95 % CI 64 %, 65 %). In unadjusted analyses, younger age, minority race/ethnicity, poverty, shorter disease duration, fewer physician visits, and lack of health insurance, were associated with lower pass rates. Receiving care in public sector managed care organizations was associated with higher pass rates. After adjustment, younger age, having fewer physician visits and lacking health insurance remained significantly associated with lower performance; receiving care in public sector managed care organizations remained associated with higher performance.
We identified a number of gaps in clinical care for SLE. Factors associated with the health care system, including presence and type of health insurance, were the primary determinants of performance on quality measures in SLE.
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- Quality of Care in Systemic Lupus Erythematosus: Application of Quality Measures to Understand Gaps in Care
Journal of General Internal Medicine
Volume 27, Issue 10 , pp 1326-1333
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- systemic lupus erythematosus
- quality of health care
- Industry Sectors
- Jinoos Yazdany MD, MPH (1) (6)
- Laura Trupin MPH (1) (2)
- Chris Tonner MPH (1) (2)
- R. Adams Dudley MD (2) (3)
- Joann Zell MD (4)
- Pantelis Panopalis MD (5)
- Gabriela Schmajuk MD, MSc (1)
- Laura Julian PhD (1) (6)
- Patricia Katz PhD (1) (2) (6)
- Lindsey A. Criswell MD, MPH (1) (6)
- Edward Yelin PhD (1) (2) (6)
- Author Affiliations
- 1. Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco, CA, USA
- 6. Division of Rheumatology, University of California, San Francisco, Box 0920, San Francisco, CA, 94143-0920, USA
- 2. Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- 3. Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
- 4. Division of Rheumatology, National Jewish Health, Denver, CO, USA
- 5. Division of Rheumatology, McGill University, Montreal, Quebec, Canada