Osteoporosis and cardiovascular disease care in systemic lupus erythematosus according to new quality indicators.
OBJECTIVE
Quality indicators (QIs) for the assessment of care of patients with systemic lupus erythematosus (SLE) have been proposed. We evaluated care according to these proposed QIs for osteoporosis and cardiovascular disease (CVD) in patients with SLE in our rheumatology practice.


METHODS
We selected 200 patients with SLE according to American College of Rheumatology Criteria and ≥2 visits to our practice in 2007 to 2008. We performed a structured medical record review and collected demographics, SLE and past medical history, medications, laboratories and data concerning osteoporosis, and CVD management. We employed univariable analyses and multivariable regression analyses to test for factors associated with care meeting the proposed QIs.


RESULTS
Ninety-four percent of patients were female and 64% were white. Mean age was 46.3 years and mean lupus duration was 15.3 years. Twenty-nine percent were taking ≥7.5 mg prednisone per day for ≥3 months. The proportions of patients for whom care met the proposed QIs were as follows: 59% for bone mineral density testing, 62% for calcium and vitamin D supplementation, and 86% for antiresorptive or anabolic osteoporosis medications. Only 3% had 5 cardiac risk factors assessed within the year and 26% had 4 cardiac risk factors assessed annually. Smoking, fasting lipid panels, and diabetes mellitus were rarely assessed annually. Having a primary care physician within our health care network increased care meeting QIs.


CONCLUSIONS
Care according to newly proposed QIs for osteoporosis and CVD was suboptimal in our academic center. To standardize and improve care of patients with SLE, we suggest specific changes to the proposed QIs.
Demas
Kristina L
KL
George Washington School of Medicine, Washington, DC, USA. KCostenbader@partners.org
Keenan
Brendan T
BT
Solomon
Daniel H
DH
Yazdany
Jinoos
J
Costenbader
Karen H
KH
D000328:Adult; D015519:Bone Density / Q000502:physiology; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D008055:Lipids / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
D005938:Glucocorticoids; D008055:Lipids