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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] [What about the content of this article? (0)] [Affiliation(s)] [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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