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

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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.

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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

  1. Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco, CA, USA

    Jinoos Yazdany MD, MPH, Laura Trupin MPH, Chris Tonner MPH, Gabriela Schmajuk MD, MSc, Laura Julian PhD, Patricia Katz PhD, Lindsey A. Criswell MD, MPH & Edward Yelin PhD

  2. Institute for Health Policy Studies, University of California, San Francisco, CA, USA

    Laura Trupin MPH, Chris Tonner MPH, R. Adams Dudley MD, Patricia Katz PhD & Edward Yelin PhD

  3. Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA

    R. Adams Dudley MD

  4. Division of Rheumatology, National Jewish Health, Denver, CO, USA

    Joann Zell MD

  5. Division of Rheumatology, McGill University, Montreal, Quebec, Canada

    Pantelis Panopalis MD

  6. Division of Rheumatology, University of California, San Francisco, Box 0920, San Francisco, CA, 94143-0920, USA

    Jinoos Yazdany MD, MPH, Laura Julian PhD, Patricia Katz PhD, Lindsey A. Criswell MD, MPH & Edward Yelin PhD

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  1. Jinoos Yazdany MD, MPH
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  2. Laura Trupin MPH
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  7. Gabriela Schmajuk MD, MSc
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  10. Lindsey A. Criswell MD, MPH
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Corresponding author

Correspondence to Jinoos Yazdany MD, MPH.

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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

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  • DOI: https://doi.org/10.1007/s11606-012-2071-z

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