title: Quality of care in systemic lupus erythematosus: application of quality measures to understand gaps in care.
abstract: BACKGROUND
  Systemic lupus erythematosus (SLE) affects 1 in 2500 Americans and is associated with significant morbidity and mortality. The recent development of SLE quality measures provides an opportunity to understand gaps in clinical care and to identify modifiable factors associated with variations in quality.
  
  
  OBJECTIVE
  To evaluate performance on SLE quality measures as well as differences in quality of care by demographic, socioeconomic, disease, and health system characteristics.
  
  
  METHODS
  Cross-sectional analysis of data derived from the Lupus Outcomes Study, a prospective, longitudinal study of 814 individuals. Principal data collection was through annual structured telephone surveys between 2009-2010. Data on 13 SLE quality measures was collected. We used regression models to estimate demographic, socioeconomic, disease, and health system characteristics associated with performance on individual and overall quality measures.
  
  
  METHODS
  Performance on each quality measure and overall performance on all measures for which participants were eligible (pass rate).
  
  
  RESULTS
  Participants were eligible for a mean of five measures (range 2-12). Performance varied from 29 % (assessment of cardiovascular risk factors) to 90 % (sun avoidance counseling). The overall pass rate was 65 % (95 % CI 64 %, 65 %). In unadjusted analyses, younger age, minority race/ethnicity, poverty, shorter disease duration, fewer physician visits, and lack of health insurance, were associated with lower pass rates. Receiving care in public sector managed care organizations was associated with higher pass rates. After adjustment, younger age, having fewer physician visits and lacking health insurance remained significantly associated with lower performance; receiving care in public sector managed care organizations remained associated with higher performance.
  
  
  CONCLUSIONS
  We identified a number of gaps in clinical care for SLE. Factors associated with the health care system, including presence and type of health insurance, were the primary determinants of performance on quality measures in SLE.
authors.affiliation: Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco, CA 94143-0920, USA. jinoos.yazdany@ucsf.edu
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Chris
authors.initials: C
authors.lastname: Tonner
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
authors.forename: Joann
authors.initials: J
authors.lastname: Zell
authors.forename: Pantelis
authors.initials: P
authors.lastname: Panopalis
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
authors.forename: Laura
authors.initials: L
authors.lastname: Julian
authors.forename: Patricia
authors.initials: P
authors.lastname: Katz
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Criswell
authors.forename: Edward
authors.initials: E
authors.lastname: Yelin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology / Q000592:standards*; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000208:ethnology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D055815:Young Adult