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.
Similar content being viewed by others
References
Chakravarty EF, Bush TM, Manzi S, Clarke AE, Ward MM. Prevalence of adult systemic lupus erythematosus in California and Pennsylvania in 2000: estimates obtained using hospitalization data. Arthritis Rheum. 2007;56(6):2092–2094.
Fessel WJ. Epidemiology of systemic lupus erythematosus. Rheum Dis Clin North Am. 1988;14(1):15–23.
Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum. 2008;58(1):15–25.
Maisonneuve P, Agodoa L, Gellert R, et al. Distribution of primary renal diseases leading to end-stage renal failure in the United States, Europe, and Australia/New Zealand: results from an international comparative study. Am J Kidney Dis. 2000;35(1):157–165.
Bernatsky S, Boivin JF, Joseph L, et al. Mortality in systemic lupus erythematosus. Arthritis Rheum. 2006;54(8):2550–2557.
Yazdany J, Tonner C, Trupin L, et al. Provision of preventive health care in systemic lupus erythematosus: data from a large observational cohort study. Arthritis Res Ther. 2010;12(3):R84.
Demas KL, Keenan BT, Solomon DH, Yazdany J, Costenbader KH. Osteoporosis and Cardiovascular Disease Care in Systemic Lupus Erythematosus According to New Quality Indicators. Semin Arthritis Rheum. Apr 6 2010.
Schmajuk G, Yelin E, Chakravarty E, Nelson LM, Panopolis P, Yazdany J. Osteoporosis screening, prevention, and treatment in systemic lupus erythematosus: application of the systemic lupus erythematosus quality indicators. Arthritis Care Res (Hoboken). 2010;62(7):993–1001.
Bernatsky SR, Cooper GS, Mill C, Ramsey-Goldman R, Clarke AE, Pineau CA. Cancer screening in patients with systemic lupus erythematosus. J Rheumatol. 2006;33(1):45–49.
Yazdany J, Panopalis P, Gillis JZ, et al. A quality indicator set for systemic lupus erythematosus. Arthritis Rheum. 2009;61(3):370–377. PMCID: PMC2748348.
Yelin E, Trupin L, Katz P, et al. Work dynamics among persons with systemic lupus erythematosus. Arthritis Rheum. 2007;57(1):56–63.
Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982;25(11):1271–1277.
Yazdany J, Yelin EH, Panopalis P, Trupin L, Julian L, Katz PP. Validation of the systemic lupus erythematosus activity questionnaire in a large observational cohort. Arthritis Rheum. 2008;59(1):136–143.
Karlson EW, Daltroy LH, Rivest C, et al. Validation of a Systemic Lupus Activity Questionnaire (SLAQ) for population studies. Lupus. 2003;12(4):280–286.
Medical Expenditure Panel Survey. Available at: http://www.meps.ahrq.gov/mepsweb/. Accessed April 2, 2012.
Walter LC, Lindquist K, Nugent S, et al. Impact of age and comorbidity on colorectal cancer screening among older veterans. Ann Intern Med. 2009;150(7):465–473.
Fenton JJ, Cai Y, Weiss NS, et al. Delivery of cancer screening: how important is the preventive health examination? Arch Intern Med. 2007;167(6):580–585.
Landon BE, Schneider EC, Normand SL, Scholle SH, Pawlson LG, Epstein AM. Quality of care in Medicaid managed care and commercial health plans. JAMA. 2007;298(14):1674–1681.
Thompson JW, Ryan KW, Pinidiya SD, Bost JE. Quality of care for children in commercial and Medicaid managed care. JAMA. 2003;290(11):1486–1493.
Zhang JX, Huang ES, Drum ML, et al. Insurance status and quality of diabetes care in community health centers. Am J Public Health. 2009;99(4):742–747.
2010 National Committee for Quality Assurance’s Quality Compass® Available at: http://www.ncqa.org/tabid/60/Default.aspx. Accessed April 12, 2012.
Schmajuk G, Yazdany J, Trupin L, Yelin E. Hydroxychloroquine treatment in a community-based cohort of patients with systemic lupus erythematosus. Arthritis Care Res. 2010;62(3):386–392.
Yazdany J, Trupin L, Kaiser R, Schmajuk G, Gillis JZ, Schwarz EB. Contraceptive counseling and use in SLE: A gap in health care quality? (In press, Arthritis Care & Research, 2010).
Ward MM. Association between physician volume and in-hospital mortality in patients with systemic lupus erythematosus. Arthritis Rheum. 2005;52(6):1646–1654.
Ward MM. Hospital experience and mortality in patients with systemic lupus erythematosus. Arthritis Rheum. 1999;42(5):891–898.
Ward MM. Hospital experience and expected mortality in patients with systemic lupus erythematosus: a hospital level analysis. J Rheumatol. 2000;27(9):2146–2151.
Ward MM. Medical insurance, socioeconomic status, and age of onset of endstage renal disease in patients with lupus nephritis. J Rheumatol. 2007;34(10):2024–2027.
Ward MM, Odutola JJ. Inter-hospital transfers of patients with systemic lupus erythematosus: characteristics, predictors, and outcomes. J Rheumatol. 2006;33(8):1578–1585.
Mangtani P, Shah A, Roberts JA. Validation of influenza and pneumococcal vaccine status in adults based on self-report. Epidemiol Infect. 2007;135(1):139–143.
Rauscher GH, Johnson TP, Cho YI, Walk JA. Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2008;17(4):748–757.
Skull SA, Andrews RM, Byrnes GB, et al. Validity of self-reported influenza and pneumococcal vaccination status among a cohort of hospitalized elderly inpatients. Vaccine. 2007;25(25):4775–4783.
Zimmerman RK, Raymund M, Janosky JE, Nowalk MP, Fine MJ. Sensitivity and specificity of patient self-report of influenza and pneumococcal polysaccharide vaccinations among elderly outpatients in diverse patient care strata. Vaccine. 2003;21(13–14):1486–1491.
Fowles JB, Rosheim K, Fowler EJ, Craft C, Arrichiello L. The validity of self-reported diabetes quality of care measures. Int J Qual Health Care. 1999;11(5):407–412.
Acknowledgements
The authors would like to thank Kimberly Ho for her assistance with data collection.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Grant Support
K23 AR060259, R01 AR056476, Arthritis Foundation, P60 AR053308, State of California Lupus Fund
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM. 1
(DOC 285 kb)
Rights and permissions
About this article
Cite this article
Yazdany, J., Trupin, L., Tonner, C. et al. Quality of Care in Systemic Lupus Erythematosus: Application of Quality Measures to Understand Gaps in Care. J GEN INTERN MED 27, 1326–1333 (2012). https://doi.org/10.1007/s11606-012-2071-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-012-2071-z