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Schletzbaum M, Powell WR, Garg S, Kramer J, Astor BC, Gilmore-Bykovskyi A, Kind AJ, Bartels CM. Receipt of rheumatology care and lupus-specific labs among young adults with systemic lupus erythematosus: A US Medicare retention in care cohort study. Lupus 2024; 33:804-815. [PMID: 38631342 PMCID: PMC11139576 DOI: 10.1177/09612033241247905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE In systemic lupus erythematosus, poor disease outcomes occur in young adults, patients identifying as Black or Hispanic, and socioeconomically disadvantaged patients. These identities and social factors differentially shape care access and quality that contribute to lupus health disparities in the US. Thus, our objective was to measure markers of care access and quality, including rheumatology visits (longitudinal care retention) and lupus-specific serology testing, by race and ethnicity, neighborhood disadvantage, and geographic context. METHODS This cohort study used a geo-linked 20% national sample of young adult Medicare beneficiaries (ages 18-35) with lupus-coded encounters and a 1-year assessment period. Retention in lupus care required a rheumatology visit in each 6-month period, and serology testing required ≥1 complement or dsDNA antibody test within the year. Multivariable logistic regression models were fit for visit-based retention and serology testing to determine associations with race and ethnicity, neighborhood disadvantage, and geography. RESULTS Among 1,036 young adults with lupus, 39% saw a rheumatologist every 6 months and 28% had serology testing. White beneficiaries from the least disadvantaged quintile of neighborhoods had higher visit-based retention than other beneficiaries (64% vs 30%-60%). Serology testing decreased with increasing neighborhood disadvantage quintile (aOR 0.80; 95% CI 0.71, 0.90) and in the Midwest (aOR 0.46; 0.30, 0.71). CONCLUSION Disparities in care, measured by rheumatology visits and serology testing, exist by neighborhood disadvantage, race and ethnicity, and region among young adults with lupus, despite uniform Medicare coverage. Findings support evaluating lupus care quality measures and their impact on US lupus outcomes.
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Affiliation(s)
- Maria Schletzbaum
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - W. Ryan Powell
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Shivani Garg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Joseph Kramer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Brad C. Astor
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Andrea Gilmore-Bykovskyi
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Amy J Kind
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Christie M Bartels
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
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Serna-Peña G, Castillo-de la Garza RJ, Garcia-Arellano G, Cardenas-de la Garza JA, Aguilar-Rivera LR, de Leon-Perez AA, Aguilar-Rivera E, Vazquez-Perez CE, Galarza-Delgado DA, Esquivel-Valerio JA. Quality indicators and satisfaction with care in patients with systemic lupus erythematosus. Rheumatol Int 2024; 44:831-837. [PMID: 37610651 DOI: 10.1007/s00296-023-05429-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
Grading the quality of care in patients with systemic lupus erythematosus and determining its relationship with care satisfaction may recognize gaps that could lead to better clinical practice. Eighteen quality indicators (QIs) were recently developed and validated for patients with SLE based on the 2019 EULAR management recommendations. Few studies have analyzed the relationship between quality of care and care satisfaction in patients with lupus. This was a cross-sectional study. We included patients at least 18 years old who met the EULAR/ACR 2019 classification criteria for SLE. We interviewed patients and retrieved data from medical records to assess their compliance with a set of 18 EULAR-based QIs. We calculated each QI fulfillment as the proportion of fulfilled QI divided by the number of eligible patients for each indicator. Care satisfaction was evaluated with the satisfaction domain of LupusPRO version 1.7. Spearman correlation coefficient was used to determine the relationship between quality of care and care satisfaction. Seventy patients with a median age of 33 (IQR 23-48) were included, 90% were women. Overall adherence was 62.29%. The median care satisfaction was 100. Global adherence to the 18-QIs and the care satisfaction score revealed no correlation (r = 0.064, p = 0.599). Higher QI fulfillment was found in the group with remission versus the moderate-high activity group (p = 0.008). In our study, SLE patients in remission had higher fulfillment of quality indicators. We found no correlation between the quality of care and satisfaction with care.
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Affiliation(s)
- Griselda Serna-Peña
- Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, (Rheumatology Service), Monterrey, Nuevo Leon, Mexico
| | - Rodrigo J Castillo-de la Garza
- Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, (Rheumatology Service), Monterrey, Nuevo Leon, Mexico
| | - Gisela Garcia-Arellano
- Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, (Rheumatology Service), Monterrey, Nuevo Leon, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, (Rheumatology Service), Monterrey, Nuevo Leon, Mexico
| | - Leonardo R Aguilar-Rivera
- Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, (Rheumatology Service), Monterrey, Nuevo Leon, Mexico
| | - Axel A de Leon-Perez
- Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, (Rheumatology Service), Monterrey, Nuevo Leon, Mexico
| | - Estefania Aguilar-Rivera
- Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, (Rheumatology Service), Monterrey, Nuevo Leon, Mexico
| | - Camila E Vazquez-Perez
- Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, (Rheumatology Service), Monterrey, Nuevo Leon, Mexico
| | - Dionicio A Galarza-Delgado
- Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, (Rheumatology Service), Monterrey, Nuevo Leon, Mexico
| | - Jorge A Esquivel-Valerio
- Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, (Rheumatology Service), Monterrey, Nuevo Leon, Mexico.
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Chang JC, Varghese SA, Behrens EM, Gmuca S, Kennedy JS, Liebling EJ, Lerman MA, Mehta JJ, Rutstein BH, Sherry DD, Stingl CJ, Weaver LK, Weiss PF, Burnham JM. Improving Outcomes of Pediatric Lupus Care Delivery With Provider Goal-Setting Activities and Multidisciplinary Care Models. Arthritis Care Res (Hoboken) 2023; 75:2267-2276. [PMID: 37070611 PMCID: PMC10582195 DOI: 10.1002/acr.25134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The present study was undertaken to evaluate high-quality care delivery in the context of provider goal-setting activities and a multidisciplinary care model using an electronic health record (EHR)-enabled pediatric lupus registry. We then determined associations between care quality and prednisone use among youth with systemic lupus erythematosus (SLE). METHODS We implemented standardized EHR documentation tools to autopopulate a SLE registry. We compared pediatric Lupus Care Index (pLCI) performance (range 0.0-1.0; 1.0 representing perfect metric adherence) and timely follow-up 1) before versus during provider goal-setting activities and population management, and 2) in a multidisciplinary lupus nephritis versus rheumatology clinic. We estimated associations between pLCI and subsequent prednisone use adjusted for time, current medication, disease activity, clinical features, and social determinants of health. RESULTS We analyzed 830 visits by 110 patients (median 7 visits per patient [interquartile range 4-10]) over 3.5 years. The provider-directed activity was associated with improved pLCI performance (adjusted β 0.05 [95% confidence interval (95% CI) 0.01, 0.09]; mean 0.74 versus 0.69). Patients with nephritis in multidisciplinary clinic had higher pLCI scores (adjusted β 0.06 [95% CI 0.02, 0.10]) and likelihood of timely follow-up than those in rheumatology (adjusted relative risk [RR] 1.27 [95% CI 1.02, 1.57]). A pLCI score of ≥0.50 was associated with 0.72-fold lower adjusted risk of subsequent prednisone use (95% CI 0.53, 0.93). Minoritized race, public insurance, and living in areas with greater social vulnerability were not associated with reduced care quality or follow-up, but public insurance was associated with higher risk of prednisone use. CONCLUSION Greater attention to quality metrics is associated with better outcomes in childhood SLE. Multidisciplinary care models with population management may additionally facilitate equitable care delivery.
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Affiliation(s)
- Joyce C. Chang
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
- Division of Immunology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Shreya A. Varghese
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Edward M. Behrens
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Sabrina Gmuca
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, A CHOP Research Institute Center for Emphasis, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jane S. Kennedy
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily J. Liebling
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa A. Lerman
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Jay J. Mehta
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Beth H. Rutstein
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - David D. Sherry
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Cory J. Stingl
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Lehn K. Weaver
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela F. Weiss
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, A CHOP Research Institute Center for Emphasis, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jon M. Burnham
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
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Arora S, Block JA, Nika A, Sequeira W, Katz P, Jolly M. Does higher quality of care in systemic lupus erythematosus translate to better patient outcomes? Lupus 2023; 32:771-780. [PMID: 37121602 DOI: 10.1177/09612033231172664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE To assess if high quality of care (QOC) in SLE results in improved outcomes of quality of life (QOL) and non-routine health care utilization (HCU). METHODS One hundred and forty consecutive SLE patients were recruited from the Rheumatology clinic at an academic center. Data on QOC and QOL were collected along with demographics, socio-economic, and disease characteristics at baseline. LupusPRO assessing health-related (HR) QOL and non (N)HRQOL was utilized. Follow up QOL and HCU were collected prospectively at 6 months. High QOC was defined as those meeting ≥80% of the eligible quality indicators. Univariate and multivariate regression analyses were performed with QOC and high QOC as independent variables and HRQOL and NHRQOL as dependent variables at baseline and follow up. Multivariable models were adjusted for demographics and disease characteristics. Secondary outcomes included non-routine HCU and disease activity at follow up. RESULTS Baseline and follow up data on 140 and 94 patients, respectively, were analyzed. Mean (SD) performance rate (QOC) was 78.6 (13.4) with 52% patients in the high QOC group. QOC was associated with better NHRQOL at baseline and follow up but not with HRQOL. Of all the NHRQOL domains, QOC was positively associated with treatment satisfaction. QOC or high QOC were not associated with non-routine HCU and were instead associated with higher disease activity at follow up. CONCLUSION Higher QOC predicted better NHRQOL by directly impacting treatment satisfaction in SLE patients in this cohort. Higher QOC, however, was not associated with HRQOL, HCU, or improvement in disease activity at follow up.
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Affiliation(s)
- Shilpa Arora
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Joel A Block
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Ailda Nika
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Winston Sequeira
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Patricia Katz
- Department of Rheumatology, University of California, San Francisco, CA, USA
| | - Meenakshi Jolly
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
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Sand-Svartrud AL, Berdal G, Azimi M, Bø I, Dager TN, Eppeland SG, Fredheim GO, Hagland AS, Klokkeide Å, Linge AD, Sexton J, Tennebø K, Valaas HL, Mjøsund K, Dagfinrud H, Kjeken I. Associations between quality of health care and clinical outcomes in patients with rheumatic and musculoskeletal diseases: a rehabilitation cohort study. BMC Musculoskelet Disord 2022; 23:357. [PMID: 35428256 PMCID: PMC9011960 DOI: 10.1186/s12891-022-05271-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The quality of provided health care may be an important source of variation in rehabilitation outcomes, increasing the interest in associations between quality indicators (QIs) and improved patient outcomes. Therefore, we examined the associations between the quality of rehabilitation processes and subsequent clinical outcomes among patients with rheumatic and musculoskeletal diseases (RMDs). METHODS In this multicentre prospective cohort study, adults with RMDs undergoing multidisciplinary rehabilitation at eight participating centres reported the quality of rehabilitation after 2 months and outcomes after 2, 7, and 12 months. We measured perceived quality of rehabilitation by 11 process indicators that cover the domains of initial assessments, patient participation and individual goal-setting, and individual follow-up and coordination across levels of health care. The patients responded "yes" or "no" to each indicator. Scores were calculated as pass rates (PRs) from 0 to 100% (best score). Clinical outcomes were goal attainment (Patient-Specific Functional Scale), physical function (30 s sit-to-stand test), and health-related quality of life (EuroQoL 5D-5L). Associations between patient-reported quality of care and each outcome measure at 7 months was analysed by linear mixed models. RESULTS A total of 293 patients were enrolled in this study (mean age 52 years, 76% female). Primary diagnoses were inflammatory rheumatic disease (64%), fibromyalgia syndrome (18%), unspecific neck, shoulder, or low back pain (8%), connective tissue disease (6%), and osteoarthritis (4%). The overall median PR for the process indicators was 73% (range 11-100%). The PR was lowest (median 40%) for individual follow-up and coordination across levels of care. The mixed model analyses showed that higher PRs for the process indicators were not associated with improved goal attainment or improved physical function or improved health-related quality of life. CONCLUSIONS The quality of rehabilitation processes was not associated with important clinical outcomes. An implication of this is that measuring only the outcome dimension of quality may result in incomplete evaluation and monitoring of the quality of care, and we suggest using information from both the structure, process, and outcome dimensions to draw inferences about the quality, and plan future quality initiatives in the field of complex rehabilitation. TRIAL REGISTRATION The study is part of the larger BRIDGE trial (ClinicalTrials.gov NCT03102814 ).
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Affiliation(s)
- Anne-Lene Sand-Svartrud
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway.
| | - Gunnhild Berdal
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Maryam Azimi
- Patient Advisory Board, Division of Rheumatology and Research Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Bø
- Hospital for Rheumatic Diseases Lillehammer, Margrethe Grundtvigs veg 6, N-2609, Lillehammer, Norway
| | - Turid Nygaard Dager
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Siv Grødal Eppeland
- Sørlandet Hospital Arendal, PO Box 416, Lundsiden, N-4604, Kristiansand, Norway
| | | | - Anne Sirnes Hagland
- Hospital for Rheumatic Diseases Haugesund, PO Box 2175, N-5504, Haugesund, Norway
| | - Åse Klokkeide
- Rehabilitering Vest Rehabilitation Centre, PO Box 2175,, N-5504, Haugesund, Norway
| | - Anita Dyb Linge
- Muritunet Rehabilitation Centre, Grandedata 58, N-6210, Valldal, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kjetil Tennebø
- Valnesfjord Health Sports Centre, Østerkløftveien 249, N-8215, Valnesfjord, Norway
| | | | - Kristin Mjøsund
- Meråker Rehabilitation Centre, Østigardsveien 24, N-7530, Meråker, Norway
| | - Hanne Dagfinrud
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
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Garg S, Singh T, Panzer SE, Astor BC, Bartels CM. Multidisciplinary Lupus Nephritis Clinic Reduces Time to Renal Biopsy and Improves Care Quality. ACR Open Rheumatol 2022; 4:581-586. [PMID: 35396828 PMCID: PMC9274336 DOI: 10.1002/acr2.11435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Patients with lupus nephritis (LN) have a 26‐fold higher mortality rate compared with their peers. Kidney biopsy, the gold standard diagnostic method for LN, may have an average wait time of more than 50 days. Other gaps in quality process measures during LN visits have also been reported. A subspecialty multidisciplinary clinic (MDC) can provide better care and quality in LN; therefore, we aimed to examine how an LN MDC impacted time to biopsy, time to treatment, and other quality measures. Methods We included all validated patients with LN who underwent diagnostic kidney biopsies between the 2011 to 2017 pre‐MDC period and the 2018 to 2020 post‐MDC period. We compared time to biopsy and treatment and quality measures between the two periods and examined factors associated with timely LN diagnosis, defined as a biopsy within 21 days. Results During the pre‐ and post‐MDC periods, 53 and 21 patients with LN underwent a diagnostic biopsy, respectively. We found a decrease in the median time to biopsy from 26 days to 16 days after starting the LN clinic (P = 0.014). Beyond clinical factors, the presence of social factors, such as being of a non‐White race and having food insecurity, were associated with 54% lower odds of timely diagnosis (adjusted Hazards Ratio [aHR] = 0.46; 95% confidence interval: 0.22‐0.93; P = 0.031). We found higher odds of quality measure performance during the post‐ versus pre‐MDC period. Conclusion Wait times to diagnose LN decreased by 40% and higher quality measure performance was noted after establishing an LN MDC. Systemic and social barriers predicted delays in diagnosis that may be addressed by MDCs.
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Arora S, Nika A, Sequeira W, Block JA, Jolly M. Pneumococcal Vaccination Among Lupus Patients: Who Are the Recipients? J Clin Rheumatol 2021; 27:e456-e461. [PMID: 32804752 DOI: 10.1097/rhu.0000000000001536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pneumococcal vaccination (PV) is indicated for the elderly (age ≥65 years) and those with chronic disease or who are immunosuppressed. We aimed to study the rate and predictors of recommendation/receipt of 23 valent pneumococcal polysaccharide vaccine (PPSV23) in immunosuppressed systemic lupus erythematosus (SLE) patients. METHODS Data were obtained through self-report questionnaires and medical chart review of 150 SLE patients. Information on rheumatologist recommendation or receipt of PPSV23 in the preceding 5 years was collected if self-reported in a questionnaire or documented in the medical chart. Chart review was also done to collect data on patient demographics, physician characteristics (if patients had a primary care physician and rheumatologist's SLE patient volume), and the disease characteristics of SLE. Comparisons using χ2 or t tests and logistic regression analyses were conducted for predictors of recommendation/receipt of PV. RESULTS The mean (SD) age was 47.4 (15.9) years; 90% were women. Sixty-five of 94 eligible patients for PV (based on immunosuppressive medications use or age) had been either recommended or administered PPSV23. On univariate logistic regression analysis, age, duration of disease, current use of hydroxychloroquine or mycophenolate, and rheumatologist's SLE patient volume were significant correlates of recommendation/receipt of PPSV23. However, on multivariate analysis, the only significant predictor was rheumatologist's SLE patient volume after adjusting for the above correlates such that with every 50 patients increase in SLE patient clinic volume, the odds of recommendation/receipt of PPSV23 increased by 2.37 times. CONCLUSIONS The volume of lupus patients that rheumatologists see is strongly associated with the likelihood that their SLE patients will have PPSV23 recommended and delivered, suggesting a volume outcome relationship.
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Affiliation(s)
- Shilpa Arora
- From the Department of Medicine, Rush University Medical Center, Chicago, IL
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8
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Burnham JM, Cecere L, Ukaigwe J, Knight A, Peterson R, Chang JC. Factors Associated With Variation in Pediatric Systemic Lupus Erythematosus Care Delivery. ACR Open Rheumatol 2021; 3:708-714. [PMID: 34551217 PMCID: PMC8516107 DOI: 10.1002/acr2.11314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Patients with pediatric systemic lupus erythematosus (pSLE) and mixed connective tissue disease (MCTD) receive only a fraction of recommended care. Using published quality indicators and guidelines, we developed a 13‐item pediatric lupus care index (p‐LuCI) to quantify the proportion of recommended clinical evaluations and comorbidity prevention interventions completed and the timeliness of follow‐up. Our objective was to assess baseline index performance and identify sources of p‐LuCI variation. Methods We performed a cross‐sectional study in patients with pSLE or MCTD and analyzed the performance of individual p‐LuCI process metrics and calculated the overall p‐LuCI score. We identified factors associated with the p‐LuCI using multivariable linear regression with clustering by provider. Results For 110 patients (99 with pSLE and 11 with MCTD), the median p‐LuCI was 65.2% (interquartile range: 9.1‐92.3%). Component performance ranged from 27.3% (on‐time scheduling) to 95.4% (steroid‐sparing treatment). Patients with p‐LuCI scores above the median had higher scores across all 13 components. Higher p‐LuCI scores were independently associated with disease‐modifying antirheumatic drug use (β = 14.3 [95% confidence interval (CI), 1.5‐27.2]), nephritis (β = 10.4 [95% CI, 5.1‐15.8]), higher provider pSLE/MCTD volume (β = 3.1 [95% CI, 1.9‐4.2] per patient), assignment to rheumatology fellow trainee (β = 36.3 [95% CI, 17.3‐55.2]), and disease duration of less than 1 year (β = 12.6 [95% CI, 0.7‐24.5]). Differences by race, ethnicity, and/or insurance were not observed. Conclusion Using an index of recommended pSLE care metrics, we identified significant variation in performance by disease, treatment, and provider characteristics. The p‐LuCI may be useful to assess care quality at the patient, provider, and practice levels and to identify areas in need of greater standardization.
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Affiliation(s)
- Jon M Burnham
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lynsey Cecere
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joy Ukaigwe
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrea Knight
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Joyce C Chang
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Chavatza K, Kostopoulou M, Nikolopoulos D, Gioti O, Togia K, Andreoli L, Aringer M, Boletis J, Doria A, Houssiau FA, Jayne D, Mosca M, Svenungsson E, Tincani A, Bertsias G, Fanouriakis A, Boumpas DT. Quality indicators for systemic lupus erythematosus based on the 2019 EULAR recommendations: development and initial validation in a cohort of 220 patients. Ann Rheum Dis 2021; 80:1175-1182. [PMID: 34162597 DOI: 10.1136/annrheumdis-2021-220438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Quality of care is receiving increased attention in systemic lupus erythematosus (SLE). We developed quality indicators (QIs) for SLE based on the 2019 update of European League Against Rheumatism recommendations. METHODS A total of 44 candidate QIs corresponding to diagnosis, monitoring and treatment, were independently rated for validity and feasibility by 12 experts and analysed by a modified Research and Development Corporation/University of California Los Angeles model. Adherence to the final set of QIs and correlation with disease outcomes (flares, hospitalisations and organ damage) was tested in a cohort of 220 SLE patients with a median monitoring of 2 years (IQR 2-4). RESULTS The panel selected a total of 18 QIs as valid and feasible. On average, SLE patients received 54% (95% CI 52.3% to 56.2%) of recommended care, with adherence ranging from 44.7% (95% CI 40.8% to 48.6%) for diagnosis-related QIs to 84.3% (95% CI 80.6% to 87.5%) for treatment-related QIs. Sustained remission or low disease activity were achieved in 26.8% (95% CI 21.1% to 33.2%). Tapering of prednisone dose to less than 7.5 mg/day was achieved in 93.6% (95% CI 88.2% to 97.0%) while 73.5% (95% CI 66.6% to 79.6%) received the recommended hydroxychloroquine dose. Higher adherence to monitoring-related QIs was associated with reduced risk for a composite adverse outcome (flare, hospitalisation or damage accrual) during the last year of observation (OR 0.97 per 1% adherence rate, 95% CI 0.96 to 0.99). CONCLUSION We developed QIs for assessing and improving the care of SLE patients. Initial real-life data suggest face validity, but a variable degree of adherence and a need for further improvement.
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Affiliation(s)
- Katerina Chavatza
- Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Myrto Kostopoulou
- Department of Nephrology, "G. Gennimatas" General Hospital, Athens, Greece
| | - Dionysis Nikolopoulos
- Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Ourania Gioti
- Department of Rheumatology, "Asklepieion" General Hospital, Voula, Athens, Greece
| | - Konstantina Togia
- Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
| | - Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center & Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - John Boletis
- Nephrology Department and Renal Transplantation Unit, "Laikon" Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Frederic A Houssiau
- Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisabet Svenungsson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Angela Tincani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece.,Department of Rheumatology, "Asklepieion" General Hospital, Voula, Athens, Greece
| | - Dimitrios T Boumpas
- Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece .,Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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10
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Richter JG, Chehab G, Schwartz C, Ricken E, Tomczak M, Acar H, Gappa H, Velasco CA, Rosengren P, Povilionis A, Schneider M, Thestrup J. The PICASO cloud platform for improved holistic care in rheumatoid arthritis treatment-experiences of patients and clinicians. Arthritis Res Ther 2021; 23:151. [PMID: 34044850 PMCID: PMC8157758 DOI: 10.1186/s13075-021-02526-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background Multimorbidity raises the number of essential information needed for delivery of high-quality care in patients with chronic diseases like rheumatoid arthritis (RA). We evaluated an innovative ICT platform for integrated care which orchestrates data from various health care providers to optimize care management processes. Methods The Horizon2020-funded research project PICASO (picaso-project.eu) established an ICT platform that offers integration of care services across providers and supports patients’ management along the continuum of care, leaving the data with the owner. Strict conformity with ethical and legal legislations was augmented with a usability-driven engineering process, user requirements gathering from relevant stakeholders, and expert walkthroughs guided developments. Developments based on the HL7/FHIR standard granting interoperability. Platform’s applicability in clinical routine was an essential aim. Thus, we evaluated the platform according to an evaluation framework in an observational 6-month proof-of-concept study with RA patients affected by cardiovascular comorbidities using questionnaires, interviews, and platform data. Results Thirty RA patients (80% female) participated, mean age 59 years, disease duration 13 years, average number of comorbidities 2.9. Home monitoring data demonstrated high platform adherence. Evaluations yielded predominantly positive feedback: The innovative dashboard-like design offering time-efficient data visualization, comprehension, and personalization was well accepted, i.e., patients rated the platform “overall” as 2.3 (1.1) (mean (SD), Likert scales 1–6) and clinicians recommended further platform use for 93% of their patients. They managed 86% of patients’ visits using the clinician dashboard. Dashboards were valued for a broader view of health status and patient-physician interactions. Platform use contributed to improved disease and comorbidity management (i.e., in 70% physicians reported usefulness to assess patients’ diseases and in 33% potential influence on treatment decisions; risk manager was used in 59%) and empowered patients (i.e., 48% set themselves new health-related goals, 92% stated easier patient-physician communications). Conclusion Comprehensive aggregation of clinical data from distributed sources in a modern, GDPR-compliant cloud platform can improve physicians’ and patients’ knowledge of the disease status and comorbidities as well as patients’ management. It empowers patients to monitor and positively contribute to their disease management. Effects on patients’ outcome, behavior, and changes in the health care systems should be explored by implementing ICT-based platforms enriched by upcoming Artificial Intelligence features where possible. Trial registration DRKS—German Clinical Trials Register, DRKS00013637, prospectively registered. 17 January 2018.
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Affiliation(s)
- Jutta G Richter
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - Gamal Chehab
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Catarina Schwartz
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Elisabeth Ricken
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Monika Tomczak
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Hasan Acar
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Henrike Gappa
- Fraunhofer Institute for Applied Information Technology FIT, St. Augustin, Germany
| | - Carlos A Velasco
- Fraunhofer Institute for Applied Information Technology FIT, St. Augustin, Germany
| | | | | | - Matthias Schneider
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
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11
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Widdifield J, Bernatsky S, Pope JE, Kuriya B, Barber CEH, Eder L, Ahluwalia V, Ling V, Gozdyra P, Hofstetter C, Lyddiatt A, Paterson JM, Thorne C. Evaluation of Rheumatology Workforce Supply Changes in Ontario, Canada, from 2000 to 2030. ACTA ACUST UNITED AC 2021; 16:119-134. [PMID: 33720829 PMCID: PMC7957360 DOI: 10.12927/hcpol.2021.26428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rheumatology workforces are increasingly challenged by too few physicians in face of the growing burden of rheumatic and musculoskeletal diseases (RMDs). Rheumatology is one of the most frequent non-surgical specialty referrals and has the longest wait times for subspecialists. We used a population-based approach to describe changes in the rheumatology workforce, patient volumes and geographic variation in the supply of and access to rheumatologists, in Ontario, Canada, between 2000 and 2019, and projected changes in supply by 2030. Over time, we observed greater feminization of the workforce and increasing age of workforce members. We identified a large regional variation in rheumatology supply. Fewer new patients are seen annually, which likely contributes to increasing wait times and reduced access to care. Strategies and policies to raise the critical mass and improve regional distribution of supply to effectively provide rheumatology care and support the healthcare delivery of patients with RMDs are needed.
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Affiliation(s)
- Jessica Widdifield
- Scientist, Sunnybrook Research Institute Holland Bone & Joint Program; Assistant Professor, University of Toronto, Institute of Health Policy, Management & Evaluation Toronto, ON; Scientist, ICES Toronto, ON
| | - Sasha Bernatsky
- Rheumatologist and Scientist, Research Institute of the McGill University Health Centre; Associate Professor, Department of Epidemiology, McGill University, Montreal, QC
| | - Janet E Pope
- Rheumatologist, St Joseph's Health Care London; Professor of Medicine Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University London, ON
| | - Bindee Kuriya
- Rheumatologist, Sinai Health System; Assistant Professor, Department of Medicine, University of Toronto, Toronto, ON
| | - Claire E H Barber
- Rheumatologist, Assistant Professor, University of Calgary, Calgary, AB; Research Scientist, Arthritis Research Canada, Richmond, BC
| | - Lihi Eder
- Rheumatologist, Clinician Scientist, Women's College Research Institute, Toronto, ON
| | | | | | | | | | | | - J Michael Paterson
- Scientist, ICES, Toronto, ON; Assistant Professor, Department of Family Medicine, McMaster University, Hamilton, ON; Assistant Professor, University of Toronto, Institute of Health Policy, Management & Evaluation, Toronto, ON
| | - Carter Thorne
- Rheumatologist, Southlake Regional Health Centre, Newmarket, ON; Assistant Professor of Medicine, University of Toronto, Toronto, ON
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12
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Kernder A, Richter JG, Fischer-Betz R, Winkler-Rohlfing B, Brinks R, Schneider M, Chehab G. Quality of care predicts outcome in systemic lupus erythematosus: a cross-sectional analysis of a German long-term study (LuLa cohort). Lupus 2020; 29:136-143. [PMID: 31992161 PMCID: PMC6993135 DOI: 10.1177/0961203319896626] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective Our aim was to study the quality of medical care in patients with systemic lupus erythematosus (SLE) to understand gaps and to analyze the association with outcome of the disease. Methods Information on demographics and medical care was assessed by self-reported questionnaires among SLE patients (LuLa cohort, 2011, n = 580). In total, 21 aspects of medical care were analyzed. Univariate analysis selected 10 predictor variables for further analysis: (1) urine examination and (2) blood test in the previous year, (3) taking antimalarials, (4) taking vitamin D and calcium if the dosage of prednisolone was greater than 7.5 mg/day, counseling regarding (5) lipid metabolism, (6) vaccination, and (7) blood pressure, and treatment of the comorbidities (8) hypertension, (9) osteoporosis and (10) lipid metabolism disorder. The association of these 10 items with the outcome of the disease, assessed in 2015, was analyzed by linear regression analysis, adjusted for age, disease duration and sex. Results On average six of the 10 items were met (±1.7). Receiving more clinical care in 2013 was predictive for low disease activity (SLAQ, p = 0.024, β = –0.104, corr. R2 = 0.048), low progress in disease-related damage (Delta Brief Index of Lupus Questionnaire, p = 0.048, β = –0.132, corr. R2 = 0.036) and high health-related quality of life (SF-12 physical, p = 0.035, β = 0.100, corr. R2 = 0.091) in 2015. Conclusion Our study illustrates a link between the quality of care and the SLE outcome parameters disease activity, disease-related damage and quality of life. Consistent considerations of these care parameters, which are recommended in several management guidelines, could therefore be a good approach to improve the outcome of patients with SLE.
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Affiliation(s)
- A Kernder
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
| | - J G Richter
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
| | - R Fischer-Betz
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
| | | | - R Brinks
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
| | - M Schneider
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
| | - G Chehab
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
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13
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Arora S, Yazdany J. Use of Quality Measures to Identify Disparities in Health Care for Systemic Lupus Erythematosus. Rheum Dis Clin North Am 2020; 46:623-638. [PMID: 32981640 DOI: 10.1016/j.rdc.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Assessment of quality of care for people with systemic lupus erythematosus (SLE) provides opportunities to identify gaps in health care and address disparities. Poor access to specialty care has been shown to negatively impact care in SLE and is associated with poor disease outcomes. Racial/ethnic minorities and those with low socioeconomic status are at higher risk for poor access and lower quality of care. Quality measures evaluating processes of care have shown significant deficiencies in care of SLE patients across studies. High SLE patient volume correlates with better quality of care for providers in hospital and ambulatory settings.
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Affiliation(s)
- Shilpa Arora
- Division of Rheumatology, Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL 60612, USA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, 1001 Potrero Avenue, Suite 3300, San Francisco, CA 94110, USA.
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14
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Schmajuk G, Li J, Evans M, Anastasiou C, Kay JL, Yazdany J. Quality of care for patients with SLE: data from the American College of Rheumatology's RISE registry. Arthritis Care Res (Hoboken) 2020; 74:179-186. [PMID: 32937019 DOI: 10.1002/acr.24446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although multiple national quality measures focus on the management and safety of rheumatoid arthritis, few measures address the care of patients with SLE. We applied a group of quality measures relevant to the care of SLE patients and used the ACR's RISE registry to assess nationwide variations in care. METHODS Data derived from RISE and included patients with ≥2 visits with SLE codes ≥30 days apart in 2017-2018. We calculated performance on 5 quality measures: renal disease screening; blood pressure assessment and management; hydroxychloroquine (HCQ) prescribing; safe dosing for HCQ; and prolonged glucocorticoid use at doses > 7.5 mg/day. We reported performance on these measures at the practice level. We used logistic regression to assess independent predictors of performance after adjusting for sociodemographic and utilization factors. RESULTS We included 27,567 unique patients from 186 practices; 91.7% were female, 48% white, with mean age 53.5±15.2 years. Few patients had adequate screening for the development of renal manifestations (39.5%). Although blood pressure assessment was common (94.4%), a meaningful fraction had untreated hypertension (17.7%). Many received HCQ (71.5%), but only 62% at doses ≤ 5.0 mg/kg/day. Some received at least moderate-dose steroids for ≥ 90 days (18.5%). We observed significant practice variation on every measure. CONCLUSION We found potential gaps in care for patients with SLE across the U.S. Although some performance variation may be explained by differences in disease severity, dramatic differences suggest that developing quality measures to address important health care processes in SLE may improve care.
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Affiliation(s)
- Gabriela Schmajuk
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, United States.,Philip R. Lee Institute for Health Policy Research, Department of Medicine, University of California, San Francisco.,San Francisco Veterans Affairs Medical Center, San Francisco, California, United States
| | - Jing Li
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, United States
| | - Michael Evans
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, United States
| | - Christine Anastasiou
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, United States
| | - Julia L Kay
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, United States
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, United States
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15
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Jolly M, Sethi B, O'Brien C, Sequeira W, Block JA, Toloza S, Bertoli A, Blazevic I, Vilá LM, Moldovan I, Torralba KD, Cicognani E, Mazzoni D, Hasni S, Goker B, Haznedaroglu S, Bourre-Tessier J, Navarra SV, Mok CC, Clarke A, Weisman M, Wallace D. Drivers of Satisfaction With Care for Patients With Lupus. ACR Open Rheumatol 2019; 1:649-656. [PMID: 31872187 PMCID: PMC6917325 DOI: 10.1002/acr2.11085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/22/2019] [Indexed: 01/02/2023] Open
Abstract
Objective Quality of life (QOL) and quality of care (QOC) in systemic lupus erythematosus (SLE) remains poor. Satisfaction with care (SC), a QOC surrogate, correlates with health behaviors and outcomes. This study aimed to determine correlates of SC in SLE. Methods A total of 1262 patients with SLE were recruited from various countries. Demographics, disease activity (modified Systemic Lupus Erythematosus Disease Activity Index for the Safety of Estrogens in Lupus Erythematosus: National Assessment trial [SELENA‐SLEDAI]), and QOL (LupusPRO version 1.7) were collected. SC was collected using LupusPRO version 1.7. Regression analyses were conducted using demographic, disease (duration, disease activity, damage, and medications), geographic (eg, China vs United States), and QOL factors as independent predictors. Results The mean (SD) age was 41.7 (13.5) years; 93% of patients were women. On the univariate analysis, age, ethnicity, current steroid use, disease activity, and QOL (social support, coping) were associated with SC. On the multivariate analysis, Asian participants had worse SC, whereas African American and Hispanic patients had better SC. Greater disease activity, better coping, and social support remained independent correlates of better SC. Compared with US patients, patients from China and Canada had worse SC on the univariate analysis. In the multivariate models, Asian ethnicity remained independently associated with worse SC, even after we adjusted for geographic background (China). No associations between African American or Hispanic ethnicity and SC were retained when geographic location (Canada) was added to the multivariate model. Canadian patients had worse SC when compared with US patients. Higher disease activity, better social support, and coping remained associated with better SC. Conclusion Greater social support, coping, and, paradoxically, SLE disease activity are associated with better SC. Social support and coping are modifiable factors that should be addressed by the provider, especially in the Asian population. Therefore, evaluation of a patient's external and internal resources using a biopsychosocial model is recommended. Higher disease activity correlated with better SC, suggesting that the latter may not be a good surrogate for QOC or health outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Ana Bertoli
- Instituto Reumatológico Strusberg, Cordoba, Argentina
| | | | - Luis M Vilá
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | | | | | | | - Sarfaraz Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | | | | | | | - Ann Clarke
- University of Calgary, Calgary, Alberta, Canada
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16
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Kiltz U, Landewé RBM, van der Heijde D, Rudwaleit M, Weisman MH, Akkoc N, Boonen A, Brandt J, Carron P, Dougados M, Gossec L, Jongkees M, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compán V, Niederman K, Sampaio-Barros PD, Slobodin G, Van den Bosch FE, van Tubergen A, van Weely S, Wiek D, Braun J. Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis. Ann Rheum Dis 2019; 79:193-201. [PMID: 31604704 PMCID: PMC7025729 DOI: 10.1136/annrheumdis-2019-216034] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/26/2019] [Accepted: 09/28/2019] [Indexed: 12/25/2022]
Abstract
Objectives The Assessment of SpondyloArthritis International Society (ASAS) aimed to develop a set of quality standards (QS) to help improve the quality of healthcare provided to adult patients affected by axial spondyloarthritis (axSpA) worldwide. Methods An ASAS task force developed a set of QS using a stepwise approach. First, key areas for quality improvement were identified, discussed, rated and agreed on. Thereafter, areas were prioritised and statements for the most important key areas were phrased on consensus. Appropriate quality measures were defined to allow quantification of the QS at the community level. Results The ASAS task force, consisting of 20 rheumatologists, two physiotherapists and two patients, selected and proposed 34 potential key areas for quality improvement which were then commented by 140 ASAS members and patients. Within that process three new key areas came up, which led to a re-evaluation of all 37 key areas by 120 ASAS members and patients. Five key areas were identified as most important to determine quality of care: referral including rapid access, rheumatology assessment, treatment, education/self-management and comorbidities. Finally, nine QS were agreed on and endorsed by the whole ASAS membership. Conclusions ASAS successfully developed the first set of QS to help improving healthcare for adult patients with axSpA. Even though it may currently not be realistic to achieve the QS in all healthcare systems, they provide high-quality of care framework for patients with axSpA that should be aimed for.
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Affiliation(s)
- Uta Kiltz
- Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | - Robert B M Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.,Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | | | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Michael H Weisman
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, Los Angeles, California, USA
| | - Nurullah Akkoc
- Department of Medicine, Division of Rheumatology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Annelies Boonen
- Internal Medicine, Division of Rheumatology, Maastrich University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Jan Brandt
- Rheumatology, Private Practice, Berlin, Germany
| | - Philippe Carron
- Rheumatology, Ghent University Hospital, Ghent, Belgium.,VIB Inflammation Research Center, Ghent, Belgium
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France.,INSERM (U1153): Epidémiologie Clinique et Biostatistiques, PRES Sorbonne Paris-Cité, Paris, France
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), UMR S 1136, Sorbonne Universite, Paris, France.,APHP, Rheumatology department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK.,Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Anna Molto
- INSERM (U1153): Epidémiologie Clinique et Biostatistiques, PRES Sorbonne Paris-Cité, Paris, France.,Rheumatology, Hopital Cochin, paris, Ile de France, France
| | | | - Karin Niederman
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Percival Degrava Sampaio-Barros
- Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Gleb Slobodin
- Department of Internal Medicine A, Bnai Zion Medical Center, Technion, Haifa, Israel
| | - Filip E Van den Bosch
- VIB Inflammation Research Center, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
| | - Astrid van Tubergen
- Internal Medicine, Division of Rheumatology, Maastrich University Medical Center, Maastricht, The Netherlands
| | - Salima van Weely
- Reade, Centre for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
| | | | - Juergen Braun
- Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
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17
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Smitherman EA, Huang B, Furnier A, Taylor J, Burns MB, Brunner HI, Morgan EM. Quality of Care in Childhood-onset Systemic Lupus Erythematosus: Report of an Intervention to Improve Cardiovascular and Bone Health Screening. J Rheumatol 2019; 47:1506-1513. [PMID: 31474591 DOI: 10.3899/jrheum.190295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Initial benchmarking of childhood-onset systemic lupus erythematosus (cSLE) quality indicators revealed suboptimal performance across multiple centers. Our aim was to improve cardiovascular and bone health screenings at a tertiary treatment center for cSLE. This included annual measurements of vitamin D, lipid profiles, and bone mineral density through dual-energy x-ray absorptiometry (DXA). METHODS Quality improvement methodology was applied to design and implement a standardized previsit planning process to electronically entered and saved orders for needed screenings prior to a scheduled clinic visit. Process outcomes were measured using statistical process control charts. Univariate analyses were completed to assess patient-level factors. RESULTS During the study, 123 patients with cSLE participated across 619 clinic visits. The percentage of patients with completed screenings improved from 54% to 92% for annual vitamin D, 55% to 84% for annual lipid profiles, and 57% to 78% for DXA, which was sustained for more than 1 year. Providers responded to a majority of abnormal results, and improvement in the average vitamin D level was observed over time. Higher levels of disease activity, damage, number of clinic visits, and screenings completed at baseline were observed in patients with all screenings completed at the end of the intervention. CONCLUSION Implementation of elements of the chronic illness care model for cSLE management improved performance of cardiovascular and bone health screenings, a step toward preventing longterm morbidity in cSLE. Our study also suggests that more patient interaction with the healthcare system may promote successful completion of health maintenance screenings.
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Affiliation(s)
- Emily A Smitherman
- E.A. Smitherman, MD, MSCTR, Assistant Professor, Division of Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama;
| | - Bin Huang
- B. Huang, PhD, Professor, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
| | - Adam Furnier
- A. Furnier, BS, [Q.swash]uality Impro[v.alt]ement Consultant, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Janalee Taylor
- J. Taylor, MSN, APRN, CNP, M.B. Burns, RN, CPN, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Mary Beth Burns
- J. Taylor, MSN, APRN, CNP, M.B. Burns, RN, CPN, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Hermine I Brunner
- H.I. Brunner, MD, MSc, MBA, Professor, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
| | - Esi M Morgan
- E.M. Morgan, MD, MSCE, Associate Professor, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Yajima N, Tsujimoto Y, Fukuma S, Sada KE, Shimizu S, Niihata K, Takahashi R, Asano Y, Azuma T, Kameda H, Kuwana M, Kohsaka H, Sugiura-Ogasawara M, Suzuki K, Takeuchi T, Tanaka Y, Tamura N, Matsui T, Mimori T, Fukuhara S, Atsumi T. The development of quality indicators for systemic lupus erythematosus using electronic health data: A modified RAND appropriateness method. Mod Rheumatol 2019; 30:525-531. [PMID: 31111758 DOI: 10.1080/14397595.2019.1621419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: Quality indicators (QIs) are tools that standardize evaluations in terms of the minimum acceptable quality of care, presumably contributing for the better management of patients with systemic lupus erythematosus (SLE). This study aimed to develop QIs for SLE using electronic health data.Methods: The modified RAND/UCLA Appropriateness Method was used to develop the QIs. First, a literature review was conducted. Second, the candidate QI items that were available to be evaluated using the electronic health data were extracted. Third, the appropriateness of the items was assessed via rating rounds and panelists' discussions.Results: We found 3621 articles in the initial search. Finally, 34 studies were reviewed, from which 17 potential indicators were extracted as candidate QIs. Twelve indicators were selected as the final QI set through the process of appropriateness. The median appropriateness of these 12 indicators was at least 7.5, and all of them were without disagreement. The QI included assessment of disease activity, treatment of SLE, drug toxicity monitoring, treatment of glucocorticoid complications, and assessment of SLE complications.Conclusion: We formulated 12 QIs for the assessment of patients with SLE based on electronic medical data. Our QI set would be a practical tool as a quality measure.
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Affiliation(s)
- Nobuyuki Yajima
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.,Department of Nephrology and Dialysis, Kyoritsu Hospital, Kawanishi, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Sayaka Shimizu
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Kakuya Niihata
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ryo Takahashi
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshihide Asano
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Teruhisa Azuma
- Shirakawa Satellite for Teaching And Research in General Medicine, Fukushima Medical University, Shirakawa, Japan
| | - Hideto Kameda
- Division of Rheumatology, Toho University, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mayumi Sugiura-Ogasawara
- Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshihiro Matsui
- Department of Lifetime Clinical Immunology Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara Hospital, Sagamihara, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Hong J, Aspey L, Bao G, Haynes T, Lim SS, Drenkard C. Chronic Cutaneous Lupus Erythematosus: Depression Burden and Associated Factors. Am J Clin Dermatol 2019; 20:465-475. [PMID: 30877492 PMCID: PMC6534449 DOI: 10.1007/s40257-019-00429-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Depression may occur in up to 30% of individuals with cutaneous lupus erythematosus (CLE), many of whom may also have systemic manifestations. Chronic cutaneous lupus erythematosus (CCLE) conditions are less likely to present systemic involvement than acute and subacute conditions but more often cause permanent scarring and dyspigmentation. However, little is known about depression in those who have CCLE confined to the skin (primary CCLE). As African Americans are at high risk for primary CCLE and depression, we aimed to investigate the prevalence of and explore the risk factors for depression in a population-based cohort of predominantly Black patients with primary CCLE. METHODS This was a cross-sectional analysis of a cohort of individuals with a documented diagnosis of primary CCLE, established in metropolitan Atlanta, GA, USA. Participants were recruited from the Centers for Disease Control and Prevention (CDC) population-based Georgia Lupus Registry, multicenter dermatology clinics, community practices, and self-referrals. The Patient-Reported Outcomes Measurement Information System (PROMIS) was used to measure the primary outcome: depressive symptoms. Stand-alone questions were used to assess sociodemographics and healthcare utilization. Emotional, informational, and instrumental support were measured with PROMIS short forms, interpersonal processes of care with the IPC-29 survey, and skin-related quality of life with the Skindex-29+ tool. RESULTS Of 106 patients, 92 (86.8%) were female, 91 (85.8%) were Black, 45 (42.9%) were unemployed or disabled, and 28 (26.4%) reported moderate to severe depressive symptoms. Depression severity was lower in patients who were aged ≥ 60 years, were married, or had graduated from college. Univariate analysis showed that being employed (odds ratio [OR] 0.24; 95% confidence interval [CI] 0.10-0.61), insured (OR 0.23; 95% CI 0.09-0.60), reporting higher instrumental, informational, and emotional support (OR 0.75; 95% CI 0.60-0.94; OR 0.62; 95% CI 0.49-0.78; and OR 0.48; 95% CI 0.35-0.65, respectively), visiting a primary care physician in the last year (OR 0.16; 95% CI 0.04-0.61) and reporting better physician-patient interactions (OR 0.56; 95% CI 0.37-0.87) were negatively associated with depression. Patient's perception of staff disrespect (OR 2.30; 95% CI 1.19-4.47) and worse skin-related quality of life (OR 1.04; 95% CI 1.02-1.06) rendered higher risk. In multivariate analysis, only perception of staff disrespect (OR 2.35; 95% CI 1.06-5.17) and lower emotional support (OR 0.48; 95% CI 0.35-0.66) remained associated with depression. CONCLUSION Over one-quarter of a predominantly Black population-based cohort of individuals with primary CCLE reported moderate to severe depression, a rate three to five times higher than described previously in the general population from the same metropolitan Atlanta area. Our findings suggest that, while patient's perception of discrimination in the healthcare setting may play a role as a determinant of depression, social support may be protective. In addition to routine mental health screening and depression treatment, interventions directed at providing emotional support and improving office staff interpersonal interactions may contribute to reduce the risk of depression in patients with CCLE.
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Affiliation(s)
- Jennifer Hong
- Department of Medicine and Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Laura Aspey
- Department of Medicine and Department of Dermatology, Emory University, Atlanta, GA, USA
| | - Gaobin Bao
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA, USA
| | - Tamara Haynes
- Department Medicine and Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA, USA
| | - Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA, USA.
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Arora S, Nika A, Trupin L, Abraham H, Block J, Sequeira W, Yazdany J, Jolly M. Does Systemic Lupus Erythematosus Care Provided in a Lupus Clinic Result in Higher Quality of Care Than That Provided in a General Rheumatology Clinic? Arthritis Care Res (Hoboken) 2018; 70:1771-1777. [PMID: 29609210 DOI: 10.1002/acr.23569] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/27/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare the quality of care received by patients with systemic lupus erythematosus (SLE) in 2 settings within the academic institution (a dedicated lupus clinic and a general rheumatology clinic) using validated SLE quality measures. METHODS One hundred fifty consenting, consecutive SLE patients receiving longitudinal care at the Rush University general rheumatology clinic (n = 73) or the subspecialty lupus clinic (n = 77) were recruited. An updated quality measure survey and retrospective medical chart review were used to evaluate each quality measure (n = 20). The overall and individual quality measure performance was calculated and compared between the 2 groups. Data on the number of SLE patients seen by each rheumatologist were collected to assess the relationship between SLE patient volume and quality measures. RESULTS Overall quality measure performance was significantly better in SLE patients receiving care at the lupus clinic (85.8% versus 70.2% of patients receiving care at the general rheumatology clinic; P = 0.001). Differences between the 2 groups were observed for sunscreen counseling (98.7% and 83.6%, respectively; P = 0.001), antiphospholipid antibody testing (71.4% and 37%, respectively; P < 0.001), pneumococcal vaccination (84.8% and 48.8%, respectively; P < 0.001), bone mineral density testing (94.2% and 54.5%, respectively; P < 0.001), drug counseling (92.2% and 80.8%, respectively; P = 0.04), use of a steroid-sparing agent (100% and 82%, respectively; P < 0.007), use of an angiotensin-converting enzyme inhibitor (94.4% and 58.3%, respectively; P = 0.03), and cardiovascular disease risk assessment (40.3% and 15.1%, respectively; P = 0.01). There was a moderate correlation between physician volume and quality measure performance (ρ = 0.48, P < 0.001). CONCLUSION Compared with the general rheumatology clinic, the dedicated lupus clinic had better quality measure performance in this cross-sectional single-center study. In our health care system, we also observed indicators suggesting that rheumatologists with a higher volume of SLE patients provide higher quality of care.
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Affiliation(s)
| | - Ailda Nika
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Joel Block
- Rush University Medical Center, Chicago, Illinois
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Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus. Semin Arthritis Rheum 2018; 48:840-846. [PMID: 30205982 DOI: 10.1016/j.semarthrit.2018.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/30/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE), which is associated with increased stroke risk, is more prevalent and often more severe among Blacks, Asians, and Hispanics than Whites. We examined racial/ethnic variation in stroke rates and risks, overall and by hemorrhagic versus ischemic subtype, among SLE patients. METHODS Within Medicaid (2000-2010), we identified patients aged 18-65 with SLE (≥ 3 ICD-9 710.0 codes, ≥ 30days apart) and ≥12 months of continuous enrollment. Subjects were followed from index date to first stroke event, death, disenrollment, or end of follow-up. Race/ethnicity-specific annual event rates were calculated for stroke overall and by subtypes (hemorrhagic vs. ischemic). We used Cox proportional hazard models to estimate hazard ratios (HR) of stroke by race/ethnicity, adjusting for comorbidities and the competing risk of death. RESULTS Of 65,788 SLE patients, 93.1% were female. Racial/ethnic breakdown was 42% Black, 38% White, 16% Hispanic, 3% Asian, and 1% American Indian/Alaska Natives. Mean follow-up was 3.7 ± 3.0years. After multivariable adjustment, Blacks were at increased risk of overall stroke (HR 1.34 [95%CI 1.18-1.53), hemorrhagic stroke (HR 1.42 [1.00-2.01]), and ischemic stroke (HR 1.33 [1.15-1.52]) compared to Whites. Hispanics were at increased risk of overall stroke (HR 1.25 [1.06-1.47)] and hemorrhagic stroke (HR 1.79 [95% CI 1.22-2.61]), but not ischemic stroke, compared to Whites. CONCLUSION Among SLE patients enrolled in Medicaid, we observed elevated stroke risk (overall and by subtype) among Blacks and Hispanics compared to Whites, suggesting the importance of early recognition and screening for stroke risk factors among Blacks and Hispanics.
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22
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Yelin E, Yazdany J, Trupin L. Relationship Between Poverty and Mortality in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2018; 70:1101-1106. [PMID: 28973834 PMCID: PMC5882599 DOI: 10.1002/acr.23428] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/26/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A prior study established that concurrent poverty, persistent poverty, and exiting poverty were associated with the subsequent extent of damage accumulation in systemic lupus erythematosus (SLE). In this study, we examined whether concurrent poverty affects mortality after taking extent of damage accumulation into account. METHODS Analyses were conducted on 807 persons with SLE participating in the University of California-San Francisco Lupus Outcomes Study in 2009, stratified by whether they lived in households with incomes ≤125% of the federal poverty level in that year. We used Cox proportional hazards regression to estimate the risk of mortality as a function of poverty status, with and without adjustment for demographics; lupus status, including extent of disease damage; overall health status; health behaviors; and health care characteristics. RESULTS Among 807 individuals interviewed in 2009, 71 (8.8%) had died by 2015, 57 (8.3%) among the nonpoor and 14 (12.1%) among the poor (P = 0.18). With adjustment only for age, poverty in 2009 was associated with an increased risk of mortality (hazard ratio [HR] 2.14 [95% confidence interval (95% CI) 1.18-3.88]) through 2015. However, after adjustment for extent of damage and age, poverty was no longer associated with an increased risk of mortality (HR 1.68 [95% CI 0.91-3.10]). Among those who died, those who were poor lived 13.9 fewer years (95% CI 6.9-20.8; P < 0.0001). CONCLUSION The principal way that poverty results in higher mortality in SLE is by increasing the extent of damage accumulation.
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Affiliation(s)
- Edward Yelin
- Philip R Lee Institute for Health Policy Studies, UCSF
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
| | - Jinoos Yazdany
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
| | - Laura Trupin
- Philip R Lee Institute for Health Policy Studies, UCSF
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
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Sciascia S, Radin M, Roccatello D, Sanna G, Bertolaccini ML. Recent advances in the management of systemic lupus erythematosus. F1000Res 2018; 7:F1000 Faculty Rev-970. [PMID: 30026918 PMCID: PMC6039948 DOI: 10.12688/f1000research.13941.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 12/11/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease presenting highly heterogeneous clinical manifestations and multi-systemic involvement. Patients are susceptible to relapse- and remission, thus making management challenging. Moreover, a considerable number of side effects may occur with conventional therapies; therefore, there is clearly a need for new therapeutic strategies. Since the pathogenesis of SLE is highly complex, it is far from being fully understood. However, greater understanding of the pathways and of the cellular and molecular mediators involved in SLE is being achieved. Emerging evidence has allowed the development of new biological therapeutic options targeting crucial molecular mediators involved in the pathogenesis of SLE. This literature review analyzes the availability of biological and target-directed treatments, phase II and III trials, and new therapies that are being developed for the treatment of SLE.
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Affiliation(s)
- Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
| | - Massimo Radin
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
| | - Giovanni Sanna
- Louise Coote Lupus Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King’s College London, London, UK
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24
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Impact of follow-up visits on disease outcome in Chinese systemic lupus erythematosus. Clin Rheumatol 2017; 37:101-105. [PMID: 28776301 DOI: 10.1007/s10067-017-3781-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/26/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study is to determine whether the frequency of visits would affect disease activity and disease damage in patients with systemic lupus erythematosus (SLE). We recruited 147 patients who met the 1997 American College of Rheumatology (ACR) criteria for SLE. Patients were divided into three groups based on follow-up frequency: ≤ 6 visits/year (group 1), 6-12 visits/year (group 2), and > 12 visits/year (group 3). Disease activity and organ damage were evaluated using the SLE disease activity index (SLEDAI) and Systemic Lupus International Collaborative Clinics (SLICC)/ACR criteria, respectively. Data on disease features, patient characteristics, and treatment were retrospectively reviewed. We found that the SLICC score was significantly lower in patients with > 12 visits/year (P = 0.008), while the SLEDAI score showed no significant difference. The age at symptom onset (32.68 ± 13.53) and the age at SLE diagnosis (33.32 ± 13.81) in group 3 were significantly older than those in the other two groups. In univariate regression analysis, the frequency of visits, the age at symptom onset, and the age at SLE diagnosis were found to be associated with the SLICC scores. Visit frequency has no impact on SLE disease activity, but may be associated with less disease damage, an important outcome.
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25
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Yelin E, Trupin L, Yazdany J. A Prospective Study of the Impact of Current Poverty, History of Poverty, and Exiting Poverty on Accumulation of Disease Damage in Systemic Lupus Erythematosus. Arthritis Rheumatol 2017; 69:1612-1622. [PMID: 28480630 PMCID: PMC5529220 DOI: 10.1002/art.40134] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/18/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To estimate the effect of current poverty, number of years in poverty, and exiting poverty on disease damage accumulation in systemic lupus erythematosus (SLE). METHODS For this study, 783 patients with SLE were followed up from 2003 to 2015 through annual structured interviews. Respondents were categorized in each year by whether they had a household income of ≤125% of the US federal poverty level. Linear and logistic regression analyses were used to assess the impact of poverty in 2009, number of years in poverty between 2003 and 2009, and permanent exits from poverty as of 2009 on the extent of disease damage (according to the Brief Index of Lupus Damage [BILD] score) or accumulation of a clinically meaningful increase in disease damage (defined as a minimum 2-point increase in the BILD damage score) by 2015. RESULTS After adjustment for sociodemographic features, health care characteristics, and health behaviors, poverty in 2009 was associated with an increased level of accumulated disease damage in 2015 (mean difference in BILD damage score between poor and non-poor 0.62 points, 95% confidence interval [95% CI] 0.25-0.98) and increased odds of a clinically important increase in damage (odds ratio [OR] 1.67, 95% CI 0.98-2.85). Being poor in every year between 2003 and 2009 was associated with greater damage (mean change in BILD score 2.45, 95% CI 1.88-3.01) than being poor for one-half or more of those years (mean change in BILD score 1.45, 95% CI 0.97-1.93), for fewer than one-half of those years (mean change in BILD score 1.49, 95% CI 1.10-1.88), or for none of those years (mean change in BILD score 1.34, 95% CI 1.20-1.49). Those exiting poverty permanently had similar increases in disease damage (mean change in BILD score 1.30, 95% CI 0.90-1.69) as those who were never in poverty (mean change in BILD score 1.36, 95% CI 1.23-1.50) but much less damage than those who remained in poverty (mean change in BILD score 1.98, 95% CI 1.59-2.38). CONCLUSION The effects of current poverty, "dose" of poverty, and exiting poverty suggest that poverty plays a critical role in the accumulation of damage in patients with SLE.
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Affiliation(s)
- Edward Yelin
- Philip R Lee Institute for Health Policy Studies, UCSF
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
- Institute for Research on Labor and Employment, UC, Berkeley
| | - Laura Trupin
- Philip R Lee Institute for Health Policy Studies, UCSF
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
| | - Jinoos Yazdany
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
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Yelin E, Yazdany J, Trupin L. Relationship Between Process of Care and a Subsequent Increase in Damage in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2017; 69:927-932. [PMID: 27477567 DOI: 10.1002/acr.22977] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/22/2016] [Accepted: 06/28/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate whether low ratings of interactions with providers and health plans in 2013 were associated with increased systemic lupus erythematosus (SLE) damage in 2015. METHODS Data were derived from the Lupus Outcomes Study (LOS) annual surveys and include items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We used ordinary least squares regression to model the change in disease damage over a 2-year period, 2013-2015, as a function of ratings of multiple dimensions of interactions with providers and health plans, with and without adjustment for demographic characteristics, socioeconomic status, and SLE and overall health status, and logistic regression to estimate the effect of the same matrix of variables on the probability of experiencing a minimum clinically important increase in damage. RESULTS There were 566 LOS respondents who were followed from 2013-2015 and who rated their providers and health plans in 2013. After adjustment, persons with SLE rating their providers poorly in patient-provider communication experienced a significantly greater accrual of disease damage (odds ratio [OR] 0.23 [95% confidence interval (95% CI) 0.09-0.38]) and were more likely to experience a minimum clinically important increase in damage (OR 2.35 [95% CI 1.25-4.39]). After adjustment, those rating their health plan poorly on care coordination experienced a significantly greater accrual of disease damage (OR 0.19 [95% CI 0.03-0.35]) and were more likely to experience a minimum clinically important increase in damage (OR 2.20 [95% CI 1.12-4.34]). CONCLUSION Poor patient-provider communication and care coordination may result in increased disease damage.
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Affiliation(s)
- Edward Yelin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Jinoos Yazdany
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Laura Trupin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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Golder V, Hoi A. Systemic lupus erythematosus: an update. Med J Aust 2017; 206:215-220. [PMID: 28301792 DOI: 10.5694/mja16.01229] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 12/25/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease predominantly affecting women of childbearing age. New classification criteria for SLE have greater sensitivity and therefore improve the diagnostic certainty for some patients, especially those who may previously have been labelled as having undifferentiated symptoms. Uncontrolled disease activity leads to irreversible end-organ damage, which in turn increases the risk of premature death; early and sustained control of disease activity can usually be achieved by conventional immunosuppressant therapy. The development of biological therapy lags behind that for other rheumatic diseases, with belimumab being the only targeted therapy approved by the Therapeutic Goods Administration. "Treat-to-target" concepts are changing trial design and clinical practice, with evidence-based definition of response criteria in the form of remission and low disease activity now on the horizon. While new therapies are awaited, research should also focus on optimising the use of current therapy and improving the quality of care of patients with SLE.
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Golder V, Morand EF, Hoi AY. Quality of Care for Systemic Lupus Erythematosus: Mind the Knowledge Gap. J Rheumatol 2017; 44:271-278. [DOI: 10.3899/jrheum.160334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 02/03/2023]
Abstract
Systemic lupus erythematosus (SLE) is a prototypical chronic multiorgan autoimmune disorder that can lead to significant burden of disease and loss of life expectancy. The disease burden is the result of a complex interplay between genetic, biologic, socioeconomic, and health system variables affecting the individual. Recent advances in biological understanding of SLE are yet to translate to transformative therapies, and genetic and socioeconomic variables are not readily amenable to intervention. In contrast, healthcare quality, a variable readily amenable to change, has been inadequately addressed in SLE, despite evidence in other chronic diseases that quality of care is strongly associated with patient outcomes. This article will analyze the available literature on the quality of care relevant to SLE, identify knowledge gaps, and suggest ways to address this in future research.
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Casey C, Chung CP, Crofford LJ, Barnado A. Rheumatologists' perception of systemic lupus erythematosus quality indicators: significant interest and perceived barriers. Clin Rheumatol 2016; 36:97-102. [PMID: 27878408 DOI: 10.1007/s10067-016-3487-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/06/2016] [Accepted: 11/13/2016] [Indexed: 11/26/2022]
Abstract
Differences in quality of care may contribute to health disparities in systemic lupus erythematosus (SLE). Studies show low physician adherence rates to the SLE quality indicators but do not assess physician perception of SLE quality indicators or quality improvement. Using a cross-sectional survey of rheumatologists in the southeastern USA, we assessed the perception and involvement of rheumatologists in quality improvement and the SLE quality indicators. Using electronic mail, an online survey of 32 questions was delivered to 568 rheumatologists. With a response rate of 19% (n = 106), the majority of participants were male, Caucasian, with over 20 years of experience, and seeing adult patients in an academic setting. Participants had a positive perception toward quality improvement (81%) with a majority responding that the SLE quality indicators would significantly impact quality of care (54%). While 66% of respondents were familiar with the SLE quality indicators, only 18% of respondents reported using them in everyday practice. The most commonly reported barrier to involvement in quality improvement and the SLE quality indicators was time. Rheumatologists had a positive perception of the SLE quality indicators and agreed that use of the quality indicators could improve quality of care in SLE; however, they identified time as a barrier to implementation. Future studies should investigate methods to increase use of the SLE quality indicators.
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Affiliation(s)
- Carolyn Casey
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T3113 MCN, Nashville, TN, 37232, USA
| | - Cecilia P Chung
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T3113 MCN, Nashville, TN, 37232, USA
| | - Leslie J Crofford
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T3113 MCN, Nashville, TN, 37232, USA
| | - April Barnado
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T3113 MCN, Nashville, TN, 37232, USA.
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Radin M, Cecchi I, Schreiber K, Baldovino S, Rossi D, Menegatti E, Roccatello D, Sciascia S. Immunotherapies in phase II and III trials for the treatment of systemic lupus erythematosus. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2017.1257937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Massimo Radin
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Rare, Immunologic, Hematologic and Immunohematologic Diseases, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital
| | - Irene Cecchi
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Rare, Immunologic, Hematologic and Immunohematologic Diseases, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital
| | - Karen Schreiber
- Department of Thrombosis and Thrombophilia, Guy’s and St Thomas’ Hospital, London, UK
- Department of Rheumatology, Copenhagen University Hospital at Rigshospitalet, Copenhagen, Denmark
| | - Simone Baldovino
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Rare, Immunologic, Hematologic and Immunohematologic Diseases, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital
| | - Daniela Rossi
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Rare, Immunologic, Hematologic and Immunohematologic Diseases, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital
| | - Elisa Menegatti
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Rare, Immunologic, Hematologic and Immunohematologic Diseases, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Rare, Immunologic, Hematologic and Immunohematologic Diseases, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Rare, Immunologic, Hematologic and Immunohematologic Diseases, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital
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Zhang H, Chambers W, Sciascia S, Cuadrado MJ. Emerging therapies in systemic lupus erythematous: from clinical trial to the real life. Expert Rev Clin Pharmacol 2016; 9:681-94. [DOI: 10.1586/17512433.2016.1155446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Okamoto Y, Katsumata Y, Baba S, Kawaguchi Y, Gono T, Hanaoka M, Kawasumi H, Yamanaka H. Validation of the Japanese version of the Systemic Lupus Activity Questionnaire that includes physician-based assessments in a large observational cohort. Lupus 2015; 25:486-95. [DOI: 10.1177/0961203315617844] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022]
Abstract
The Systemic Lupus Activity Questionnaire (SLAQ) is a patient-reported outcome for systemic lupus erythematosus (SLE). We aimed to translate it into Japanese and further investigate its validity and reliability. The English version of the SLAQ was translated into Japanese and administered to Japanese SLE patients at our university clinic. Physicians assessed disease activity using the SLE Disease Activity Index 2000 (SLEDAI-2K). The patients were prospectively followed for repeat assessment a year later. Ultimately, 255 patients participated. The patients’ 10-point ratings of disease activity and SLAQ scores were significantly correlated (Spearman’s ρ = 0.53). The SLAQ score was weakly correlated with the SLE Disease Activity Index 2000 (SLEDAI-2K)-nolab (omitting laboratory items; ρ = 0.18) but not with the SLEDAI-2K ( ρ = 0.02). These results suggested its convergent and discriminant validity. The SLAQ demonstrated acceptable internal consistency (Cronbach’s α = 0.80), and good test–retest reliability (intraclass correlation coefficient = 0.85). The effect sizes and the standardized response means of the SLAQ were as follows: clinical worsening, 0.26 and 0.31, and improvement, −0.39 and −0.41, respectively, which indicated a small but significant responsiveness. The Japanese version of the SLAQ demonstrated acceptable reliability and validity; its performance was comparable to that of the original version.
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Affiliation(s)
- Y Okamoto
- The Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Katsumata
- The Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - S Baba
- The Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Kawaguchi
- The Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - T Gono
- The Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - M Hanaoka
- The Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Kawasumi
- The Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Yamanaka
- The Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
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Østerås N, Jordan KP, Clausen B, Cordeiro C, Dziedzic K, Edwards J, Grønhaug G, Higginbottom A, Lund H, Pacheco G, Pais S, Hagen KB. Self-reported quality care for knee osteoarthritis: comparisons across Denmark, Norway, Portugal and the UK. RMD Open 2015; 1:e000136. [PMID: 26535147 PMCID: PMC4623369 DOI: 10.1136/rmdopen-2015-000136] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 12/29/2022] Open
Abstract
Objectives To assess and compare patient perceived quality of osteoarthritis (OA) management in primary healthcare in Denmark, Norway, Portugal and the UK. Methods Participants consulting with clinical signs and symptoms of knee OA were identified in 30 general practices and invited to complete a cross-sectional survey including quality indicators (QI) for OA care. A QI was considered as eligible if the participant had checked ‘Yes’ or ‘No’, and as achieved if the participant had checked ‘Yes’ to the indicator. The median percentage (with IQR and range) of eligible QIs achieved by country was determined and compared in negative binominal regression analysis. Achievement of individual QIs by country was determined and compared using logistic regression analyses. Results A total of 354 participants self-reported QI achievement. The median percentage of eligible QIs achieved (checked ‘Yes’) was 48% (IQR 28%, 64%; range 0–100%) for the total sample with relatively similar medians across three of four countries. Achievement rates on individual QIs showed a large variation ranging from 11% (referral to services for losing weight) to 67% (information about the importance of exercise) with significant differences in achievement rates between the countries. Conclusions The results indicated a potential for improvement in OA care in all four countries, but for somewhat different aspects of OA care. By exploring these differences and comparing healthcare services, ideas may be generated on how the quality might be improved across nations. Larger studies are needed to confirm and further explore the findings.
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Affiliation(s)
- N Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - K P Jordan
- Arthritis Research UK, Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University , Staffordshire , UK
| | - B Clausen
- Research Unit for Musculoskeletal Function and Physiotherapy , Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark , Odense , Denmark
| | - C Cordeiro
- Faculty of Science and Technology and Centre for Research and Development in Health (CESUAlg) , University of Algarve , Faro , Portugal ; Centre of Statistics and Applications (CEAUL), University of Lisbon , Lisbon , Portugal
| | - K Dziedzic
- Arthritis Research UK, Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University , Staffordshire , UK
| | - J Edwards
- Arthritis Research UK, Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University , Staffordshire , UK
| | - G Grønhaug
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - A Higginbottom
- Arthritis Research UK, Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University , Staffordshire , UK
| | - H Lund
- Research Unit for Musculoskeletal Function and Physiotherapy , Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark , Odense , Denmark
| | - G Pacheco
- School of Health (ESSUAlg), University of Algarve , Faro , Portugal
| | - S Pais
- School of Health (ESSUAlg), University of Algarve , Faro , Portugal ; Centre for Research and Development in Health (CESUAlg), University of Algarve , Faro , Portugal
| | - K B Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
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Yelin E, Yazdany J, Tonner C, Trupin L, Criswell LA, Katz P, Schmajuk G. Interactions between patients, providers, and health systems and technical quality of care. Arthritis Care Res (Hoboken) 2015; 67:417-24. [PMID: 25132660 PMCID: PMC4320034 DOI: 10.1002/acr.22427] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/29/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Prior studies have established disparities by race/ethnicity and socioeconomic status (SES) in the kind, quantity, and technical quality of systemic lupus erythematosus (SLE) care and outcomes. In this study we evaluate whether disparities exist in assessments of interactions with health care providers and health plans and whether such interactions affect the technical quality of SLE care. METHODS Data derive from the Lupus Outcomes Study (LOS). Principal data collection is an annual structured phone interview including items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We use general estimating equations to assess whether disparities exist by race/ethnicity and SES in being in the lowest quartile of ratings of such interactions and whether ratings in the lowest quartile of interactions are associated with technical quality of care after adjustment for sociodemographic and disease characteristics. RESULTS In the 2012 LOS interview, there were 793 respondents, of whom 640 had ≥1 visit to their principal SLE provider. Nonwhite race/ethnicity and education were not associated with low ratings on any dimension of provider or system interaction; poverty was associated only with low ratings of health plan interactions. After adjustment for demographics, SLE status, and health care variables, ratings in the lowest quartile on all dimensions were associated with significantly lower technical quality of care. CONCLUSION Ratings in the lowest quartile on all dimensions of interactions with providers and the health care system were associated with lower technical quality of care, potentially resulting in poorer SLE outcomes.
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Affiliation(s)
- Edward Yelin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Jinoos Yazdany
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
| | - Chris Tonner
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Laura Trupin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | | | - Patricia Katz
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Gabriela Schmajuk
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
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Barber CEH, Smith A, Esdaile JM, Barnabe C, Martin LO, Faris P, Hazlewood G, Noormohamed R, Alvarez N, Mancini GBJ, Lacaille D, Keeling S, Aviña-Zubieta JA, Marshall D. Best Practices for Cardiovascular Disease Prevention in Rheumatoid Arthritis: A Systematic Review of Guideline Recommendations and Quality Indicators. Arthritis Care Res (Hoboken) 2015; 67:169-79. [DOI: 10.1002/acr.22419] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/22/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Claire E. H. Barber
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | - Alexa Smith
- Dalhousie University, Halifax; Nova Scotia Canada
| | - John M. Esdaile
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | - Cheryl Barnabe
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | | | - Peter Faris
- University of Calgary and Alberta Health Services, Calgary; Alberta Canada
| | - Glen Hazlewood
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | | | - Nanette Alvarez
- University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary; Alberta Canada
| | | | - Diane Lacaille
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | | | - J. Antonio Aviña-Zubieta
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | - Deborah Marshall
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
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