Association of clinic setting with quality indicator performance in systemic lupus erythematosus: a cross-sectional study

Association of clinic setting with quality indicator performance in systemic lupus erythematosus: a cross-sectional study

Abstract Background Healthcare quality for systemic lupus erythematosus (SLE) is a modifiable target for improving patient outcomes. We aimed to assess the quality of care processes in different clinic settings, comparing a subspecialty lupus clinic with hospital-based and private general rheumatolo...

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Published in:Arthritis research & therapy Vol. 24; no. 1; pp. 1 - 150
Main Authors: Sreedharan, Sidha, Li, Ning, Littlejohn, Geoff, Buchanan, Russell, Nikpour, Mandana, Morand, Eric, Hoi, Alberta, Golder, Vera
Format: Journal Article
Language:English
Published: London BioMed Central Ltd 22-06-2022
BioMed Central
BMC
Subjects:
Arthritis
Birth control
Care and treatment
Clinical outcomes
Clinics
Comorbidity
Comparative analysis
Counseling
Cross-sectional studies
Disease
Documentation
Health care access
Health facilities
Hospitals
Lupus
Medical care
Medical records
Patient satisfaction
Quality indicators
Quality management
Quality of care
Quality of life
Rheumatology
Systemic lupus erythematosus
Therapeutic drug monitoring
China
United States > US
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Summary:Abstract Background Healthcare quality for systemic lupus erythematosus (SLE) is a modifiable target for improving patient outcomes. We aimed to assess the quality of care processes in different clinic settings, comparing a subspecialty lupus clinic with hospital-based and private general rheumatology clinics. Methods Patients with SLE ( n = 258) were recruited in 2016 from a subspecialty lupus clinic ( n = 147), two hospital general rheumatology clinics ( n = 56) and two private rheumatology clinics ( n = 55). Data were collected from medical records and patient questionnaires. Quality of care was assessed using 31 validated SLE quality indicators (QI) encompassing diagnostic work-up, disease and comorbidity assessments, drug monitoring, preventative care and reproductive health. Per-QI performance was measured as a percentage of patients that met the QI relative to the number of patients eligible. Per-patient QI performance was calculated as a percentage of QIs met relative to the number of eligible QIs for each patient. Per-QI and per-patient QI performance were compared between the three clinic settings, and multiple regression performed to adjust for sociodemographic, disease and healthcare factors. Results Per-QI performance was generally high across all clinic settings for diagnostic work-up, comorbidity assessment, lupus nephritis, drug monitoring, prednisolone taper, osteoporosis and pregnancy care. Median [IQR] per-patient performance on eligible QIs was higher in the subspeciality lupus clinic (66.7% [57.1–74.1]) than the hospital general rheumatology (52.7% [47.5–58.1]) and private rheumatology (50.0% [42.9–60.9]) clinics ( p <0.001) and the difference remained significant after multivariable adjustment. The subspecialty lupus clinic recorded higher per-QI performance for documentation of disease activity, disease damage, cardiovascular risk factor and drug toxicity assessments, pre-immunosuppression hepatitis and tuberculosis screening, new medication counselling, vaccinations, sun avoidance education and contraception counselling. Conclusions SLE patients managed in a subspecialty lupus clinic recorded higher per-patient QI performance compared to hospital general rheumatology and private rheumatology clinics, in part related to better documentation on certain QIs.
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ISSN:1478-6362
1478-6354
1478-6362
DOI:10.1186/s13075-022-02823-9