Jinoos Yazdany1, Laura Trupin1, Gabriela Schmajuk2, Patricia P Katz3, Edward H Yelin3. 1. Department of Medicine, Division of Rheumatology, University of California, San Francisco, California, USA. 2. Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California, USA. 3. Department of Medicine, Division of Rheumatology, University of California, San Francisco, California, USA Institute for Health Policy Studies, University of California, San Francisco, California, USA.
Abstract
OBJECTIVES: Although process measures to assess quality of care in systemic lupus erythematosus (SLE) are available, their relationship to long-term outcomes has not been studied. Using a prospective, longitudinal cohort study, we examined the associations between high-quality care and two important SLE outcomes, disease activity and damage. METHODS: Data were derived from the University of California, San Francisco Lupus Outcomes Study. Participants were followed from 2009 through 2013, responding to yearly surveys. Primary outcomes in this study were clinically meaningful increases in disease activity and damage, assessed by the Systemic Lupus Activity Questionnaire (SLAQ) and the Brief Index of Lupus Damage (BILD), respectively. Using multivariable regression, we examined the relationship between high performance on 13 validated quality measures (receipt of ≥85% of quality measures), and disease outcomes, adjusting for disease status, sociodemographic characteristics, healthcare services and follow-up time. RESULTS: The 737 participants were eligible for a mean of five quality measures (SD 2, range 2-12). There were 155 and 162 participants who had clinically meaningful increases in SLAQ and BILD, respectively. In our models, we found no statistically significant relationship between performance on quality measures and changes in SLAQ. However, receiving higher-quality SLE care was significantly protective against increased disease damage (adjusted OR 0.4, 95% CI 0.4 to 0.7), even after adjusting for covariates. DISCUSSION: In this community-based cohort, we illustrate for the first time a strong link between processes of care, defined by SLE quality measures, and the subsequent accumulation of disease damage, an important outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVES: Although process measures to assess quality of care in systemic lupus erythematosus (SLE) are available, their relationship to long-term outcomes has not been studied. Using a prospective, longitudinal cohort study, we examined the associations between high-quality care and two important SLE outcomes, disease activity and damage. METHODS: Data were derived from the University of California, San Francisco Lupus Outcomes Study. Participants were followed from 2009 through 2013, responding to yearly surveys. Primary outcomes in this study were clinically meaningful increases in disease activity and damage, assessed by the Systemic Lupus Activity Questionnaire (SLAQ) and the Brief Index of Lupus Damage (BILD), respectively. Using multivariable regression, we examined the relationship between high performance on 13 validated quality measures (receipt of ≥85% of quality measures), and disease outcomes, adjusting for disease status, sociodemographic characteristics, healthcare services and follow-up time. RESULTS: The 737 participants were eligible for a mean of five quality measures (SD 2, range 2-12). There were 155 and 162 participants who had clinically meaningful increases in SLAQ and BILD, respectively. In our models, we found no statistically significant relationship between performance on quality measures and changes in SLAQ. However, receiving higher-quality SLE care was significantly protective against increased disease damage (adjusted OR 0.4, 95% CI 0.4 to 0.7), even after adjusting for covariates. DISCUSSION: In this community-based cohort, we illustrate for the first time a strong link between processes of care, defined by SLE quality measures, and the subsequent accumulation of disease damage, an important outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Kristina L Demas; Brendan T Keenan; Daniel H Solomon; Jinoos Yazdany; Karen H Costenbader Journal: Semin Arthritis Rheum Date: 2010-04-08 Impact factor: 5.532
Authors: Gabriela Schmajuk; Edward Yelin; Eliza Chakravarty; Lorene M Nelson; Pantelis Panopolis; Jinoos Yazdany Journal: Arthritis Care Res (Hoboken) Date: 2010-07 Impact factor: 4.794
Authors: E W Karlson; L H Daltroy; C Rivest; R Ramsey-Goldman; E A Wright; A J Partridge; M H Liang; P R Fortin Journal: Lupus Date: 2003 Impact factor: 2.911
Authors: C Drenkard; J Yazdany; L Trupin; P P Katz; C Dunlop-Thomas; G Bao; S S Lim Journal: Arthritis Care Res (Hoboken) Date: 2014-06 Impact factor: 4.794
Authors: Edward Yelin; Jinoos Yazdany; Chris Tonner; Laura Trupin; Lindsey A Criswell; Patricia Katz; Gabriela Schmajuk Journal: Arthritis Care Res (Hoboken) Date: 2015-03 Impact factor: 4.794
Authors: Jennifer Hong; Laura Aspey; Gaobin Bao; Tamara Haynes; S Sam Lim; Cristina Drenkard Journal: Am J Clin Dermatol Date: 2019-06 Impact factor: 7.403
Authors: Medha Barbhaiya; Candace H Feldman; Hongshu Guan; Sarah K Chen; Michael A Fischer; Daniel H Solomon; Brendan M Everett; Karen H Costenbader Journal: Semin Arthritis Rheum Date: 2018-07-31 Impact factor: 5.532
Authors: Jutta G Richter; Gamal Chehab; Catarina Schwartz; Elisabeth Ricken; Monika Tomczak; Hasan Acar; Henrike Gappa; Carlos A Velasco; Peter Rosengren; Armanas Povilionis; Matthias Schneider; Jesper Thestrup Journal: Arthritis Res Ther Date: 2021-05-27 Impact factor: 5.156