Quality of Life in Patients with Systemic Lupus Erythematosus

Abstract

Objective: We applied newly developed quality indicators (Qis) for systemic lupus erythematosus (SLE) to a large, community-based cohort of individuals to detect areas where health care quality is suboptimal and to identify groups at risk for lower quality care. Methods: Data derive from a prospective study of individuals with SLE, the Lupus Outcomes Study (LOS). In 2009, 814 individuals participated in the eighth annual survey. Respondents were queried by telephone regarding receipt of care recommended in 13 (of 20) SLE Qis amenable to self-report, as well as their sociodemographic characteristics, health care utilization, disease activity and medication use. For each QI, we calculated the proportion of eligible participants who received recommended care. In addition, we conducted multivariate analyses in which the primary outcome was a global pass rate, defined as the percentage of times recommended care was received among all eligible individuals. In these analyses, respondents contributed one observation for each eligible service, and thus there were between two and twelve observations per respondent. We accounted for these repeated measures in our regression models through generalized estimating equations, adjusting for age, sex, race/ethnicity, education, and poverty status. After eliminating observations with missing data, a total of 794 (98%) participants remained. Results: The 794 LOS participants were mostly women (92%); 48% were <55 years old; 36% were non-white; 14% had poverty level incomes; 42% had college degrees. They were eligible for 4,054 quality indicators (mean 5 ± 2 Qis/person, range 2-12 Qis). Qis with the highest rates of receipt included counseling regarding sun avoidance (90%), influenza vaccination in those receiving immunosuppressant medications (80%), and calcium and vitamin D supplementation in those taking glucocorticoids (84%) [Table]. Participants were less likely to report receiving care consistent with other Qis, including assessment of traditional cardiovascular risk factors (smoking, lipids, body-mass index, blood pressure, diabetes; 29%), and counseling regarding medication risks and contraception in women at risk for pregnancy initiating potentially teratogenic medications (40%). The global pass rate was 65%; younger age, nonwhite race/ethnicity, and low income were associated with lower global pass rates. In multivariate analysis, only younger age remained statistically significant. Discussion: In this community-based cohort of individuals with SLE, receipt of recommended care varied significantly depending on the QI assessed. For some Qis, rates of receipt of recommended care were low, suggesting the need for targeted quality improvement. Younger individuals appear to be at risk for lower quality care. (Table presented).