title: Patient-reported outcome measures in a population of medically indigent patients with systemic lupus erythematosus in Puerto Rico.
abstract: OBJECTIVE
  To determine patient-reported outcomes measures in indigent patients with systemic lupus erythematosus receiving their healthcare through the Puerto Rico government managed care system and compare these measures with non-indigent patients treated in a private fee-for-service setting.
  
  
  METHODS
  A cross-sectional study was conducted in a cohort of 98 Puerto Ricans with systemic lupus erythematosus. Patients from the public group (n = 40) were treated in a university-based specialized systemic lupus erythematosus clinic and the private group (n = 58) in a community-based rheumatology practice. Demographic and clinical features and patient-reported outcomes measures per LupusPRO instrument were determined. LupusPRO captures quality-of-life measures in 12 domains. Differences among study groups were examined using chi-square, Fisher's exact, t-tests, and the Wilcoxon signed-rank test.
  
  
  RESULTS
  The mean (standard deviation) age of the study population was 44.9 (12.0) years; 94 (95.9%) were women. Patients in the public setting were younger and were more likely to have renal disease and elevated anti-double-stranded DNA antibodies, and being treated with azathioprine and cyclophosphamide. Patients from the public sector were more likely to have better quality-of-life measures in the LupusPRO domains of pain/vitality and coping. No significant differences were observed for the domains of lupus symptoms, physical health, emotional health, body image, cognition, procreation, lupus medications, desires/goals, social support, and satisfaction with medical care.
  
  
  CONCLUSIONS
  Despite having a lower socioeconomic status and worse clinical status, systemic lupus erythematosus patients from the public sector had equal or better patient-reported outcomes measures than those treated in the private setting. This favorable outcome may be associated with the comprehensive healthcare received by these patients in a specialized lupus clinic.
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Diana V
authors.initials: DV
authors.lastname: Rodríguez-Rivera
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Yerania
authors.initials: Y
authors.lastname: Rodríguez-Navedo
authors.affiliation: Graduate Programs, San Juan Bautista School of Medicine, Caguas, Puerto Rico.
authors.forename: Mariely
authors.initials: M
authors.lastname: Nieves-Plaza
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Vilá
keywords: Puerto Rico; Systemic lupus erythematosus; patient-reported outcomes; quality of life; underserved population