title: Lupus nephritis outcomes: health maintenance organizations compared to non-health maintenance organizations.
abstract: OBJECTIVE
  Patients with systemic lupus erythematosus (SLE) in USA increasingly have their care centered in health maintenance organizations (HMO). We examined whether HMO and non-HMO SLE patients with renal involvement, who had the same university rheumatologist, differed in their utilization of health care or renal outcomes.
  
  
  METHODS
  Consecutive patients with SLE with renal involvement (n = 24), 10 enrolled in an HMO, 14 not, were studied. Laboratory values were prospectively determined.
  
  
  RESULTS
  At the first visit to the rheumatologist, there was no significant difference between HMO and non-HMO patients in laboratory values. There was no difference in the 2 groups in the final prednisone dose (HMO 12 mg vs non-HMO 15.9 mg) or use of azathioprine (20% vs. 57%; p = 0.07) or cyclophosphamide (60% vs. 57%). The serum creatinine was higher in the HMO patients (HMO 1.1 mg/dl vs. non-HMO 0.78 mg/dl; p = 0.05). No difference was found in the number of rheumatology visits. There was a significant difference in the number of communications from the rheumatologist to the HMO versus the HMO to the rheumatologist (p = 0.026).
  
  
  CONCLUSIONS
  Other than the serum creatinine, there are no differences in the treatment or renal outcomes for HMO compared to non-HMO patients with SLE seeing the same rheumatologist. There is a potential barrier in physician communication, however, with the majority of communications going from the rheumatologist to the HMO provider.
authors.affiliation: Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA.
authors.forename: M
authors.initials: M
authors.lastname: Stewart
authors.forename: M
authors.initials: M
authors.lastname: Petri
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000628:therapy*; D008181:Lupus Nephritis / Q000097:blood / Q000628:therapy*; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012219:Rheumatology / Q000706:statistics & numerical data*
chemical_list: D003404:Creatinine