title: Interactions between patients, providers, and health systems and technical quality of care.
abstract: OBJECTIVE
  Prior studies have established disparities by race/ethnicity and socioeconomic status (SES) in the kind, quantity, and technical quality of systemic lupus erythematosus (SLE) care and outcomes. In this study we evaluate whether disparities exist in assessments of interactions with health care providers and health plans and whether such interactions affect the technical quality of SLE care.
  
  
  METHODS
  Data derive from the Lupus Outcomes Study (LOS). Principal data collection is an annual structured phone interview including items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We use general estimating equations to assess whether disparities exist by race/ethnicity and SES in being in the lowest quartile of ratings of such interactions and whether ratings in the lowest quartile of interactions are associated with technical quality of care after adjustment for sociodemographic and disease characteristics.
  
  
  RESULTS
  In the 2012 LOS interview, there were 793 respondents, of whom 640 had ≥1 visit to their principal SLE provider. Nonwhite race/ethnicity and education were not associated with low ratings on any dimension of provider or system interaction; poverty was associated only with low ratings of health plan interactions. After adjustment for demographics, SLE status, and health care variables, ratings in the lowest quartile on all dimensions were associated with significantly lower technical quality of care.
  
  
  CONCLUSIONS
  Ratings in the lowest quartile on all dimensions of interactions with providers and the health care system were associated with lower technical quality of care, potentially resulting in poorer SLE outcomes.
authors.affiliation: The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
authors.forename: Edward
authors.initials: E
authors.lastname: Yelin
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.forename: Chris
authors.initials: C
authors.lastname: Tonner
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Criswell
authors.forename: Patricia
authors.initials: P
authors.lastname: Katz
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000208:ethnology / Q000592:standards*; D005006:Ethnicity; D005260:Female; D006304:Health Status; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology; D006801:Humans; D007398:Interpersonal Relations; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000191:economics / Q000208:ethnology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000592:standards*; D011369:Professional-Patient Relations; D019984:Quality Indicators, Health Care / Q000191:economics / Q000592:standards*; D044469:Racial Groups; D012219:Rheumatology / Q000191:economics / Q000592:standards*; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D012959:Socioeconomic Factors