Journal of General Internal Medicine

, Volume 27, Issue 10, pp 1326–1333

Quality of Care in Systemic Lupus Erythematosus: Application of Quality Measures to Understand Gaps in Care

  • Jinoos Yazdany
  • Laura Trupin
  • Chris Tonner
  • R. Adams Dudley
  • Joann Zell
  • Pantelis Panopalis
  • Gabriela Schmajuk
  • Laura Julian
  • Patricia Katz
  • Lindsey A. Criswell
  • Edward Yelin
Original Research

ABSTRACT

BACKGROUND

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.

OBJECTIVE

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.

OUTCOME MEASURES

Performance on each quality measure and overall performance on all measures for which participants were eligible (pass rate).

RESULTS

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.

CONCLUSIONS

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.

KEY WORDS

systemic lupus erythematosus studies outcomes quality of health care 

Supplementary material

11606_2012_2071_MOESM1_ESM.doc (285 kb)
ESM. 1(DOC 285 kb)

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Jinoos Yazdany
    • 1
    • 6
  • Laura Trupin
    • 1
    • 2
  • Chris Tonner
    • 1
    • 2
  • R. Adams Dudley
    • 2
    • 3
  • Joann Zell
    • 4
  • Pantelis Panopalis
    • 5
  • Gabriela Schmajuk
    • 1
  • Laura Julian
    • 1
    • 6
  • Patricia Katz
    • 1
    • 2
    • 6
  • Lindsey A. Criswell
    • 1
    • 6
  • Edward Yelin
    • 1
    • 2
    • 6
  1. 1.Rosalind Russell Medical Research Center for ArthritisUniversity of CaliforniaSan FranciscoUSA
  2. 2.Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoUSA
  3. 3.Division of Pulmonary and Critical Care MedicineUniversity of CaliforniaSan FranciscoUSA
  4. 4.Division of RheumatologyNational Jewish HealthDenverUSA
  5. 5.Division of RheumatologyMcGill UniversityMontrealCanada
  6. 6.Division of RheumatologyUniversity of California, San FranciscoSan FranciscoUSA

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