title: Sociodemographic and geographic predictors of quality of care in United States patients with end-stage renal disease due to lupus nephritis.
abstract: OBJECTIVE
  To describe end-stage renal disease (ESRD) quality of care (receipt of pre-ESRD nephrology care, access to kidney transplantation, and placement of permanent vascular access for dialysis) in US patients with ESRD due to lupus nephritis (LN-ESRD) and to examine whether quality measures differ by patient sociodemographic characteristics or US region.
  
  
  METHODS
  National surveillance data on patients in the US in whom treatment for LN-ESRD was initiated between July 2005 and September 2011 (n = 6,594) were analyzed. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were determined for each quality measure, according to sociodemographic factors and US region.
  
  
  RESULTS
  Overall, 71% of the patients received nephrology care prior to ESRD. Black and Hispanic patients were less likely than white patients to receive pre-ESRD care (OR 0.73 [95% CI 0.63-0.85] and OR 0.73 [95% CI 0.60-0.88], respectively) and to be placed on the kidney transplant waitlist within the first year after the start of ESRD (HR 0.78 [95% CI 0.68-0.91] and HR 0.82 [95% CI 0.68-0.98], respectively). Those with Medicaid (HR 0.51 [95% CI 0.44-0.58]) or no insurance (HR 0.36 [95% CI 0.29-0.44]) were less likely than those with private insurance to be placed on the waitlist. Only 24% had a permanent vascular access, and placement was even less likely among the uninsured (OR 0.62 [95% CI 0.49-0.79]). ESRD quality-of-care measures varied 2-3-fold across regions of the US, with patients in the Northeast and Northwest generally having higher probabilities of adequate care.
  
  
  CONCLUSIONS
  LN-ESRD patients have suboptimal ESRD care, particularly with regard to placement of dialysis vascular access. Minority race/ethnicity and lack of private insurance are associated with inadequate ESRD care. Further studies are warranted to examine multilevel barriers to, and develop targeted interventions to improve delivery of, care among patients with LN-ESRD.
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Cristina
authors.initials: C
authors.lastname: Drenkard
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.forename: Mitchel
authors.initials: M
authors.lastname: Klein
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kramer
authors.forename: Stephen
authors.initials: S
authors.lastname: Pastan
authors.forename: S Sam
authors.initials: SS
authors.lastname: Lim
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008181:Lupus Nephritis / Q000150:complications / Q000628:therapy*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists