Does SLE Care provided in a Lupus Clinic Result in Higher Quality of Care Than General Rheumatology Clinic?

PURPOSE

We compared the quality of care received by SLE patients in two settings within the same academic institution (Lupus Clinic, LC and General Rheumatology Clinic, GRC) using validated SLE quality measures (QM).

METHODS

150 consenting, consecutive SLE patients receiving longitudinal care at Rush University GRC (73) and subspecialty LC (77) were recruited. An updated QM survey and retrospective medical chart review was used for evaluation of each QM. The overall and individual (20) QM performance was calculated and compared between two groups. Data on number of SLE patients seen by each rheumatologist was collected to assess the relationship between SLE patient volume and QM.

RESULTS

Overall QM performance was significantly greater among LC SLE patients [85.8% vs. 70.2%, P= 0.001]. Differences noted among the two groups were in sunscreen counseling (98.7% vs. 83.6%, P=0.001), antiphospholipid antibody testing (71.4% vs. 37%, P< 0.001), pneumococcal vaccination (84.8% vs. 48.8%, P< 0.001), bone mineral density testing (94.2% vs. 54.5%, P<0.001), drug counseling (92.2% vs. 80.8%, P=0.04), steroid sparing agent and ACE inhibitor use (100% vs. 82%, P< 0.007 and 94.4% vs. 58.3%, P=0.03, respectively) and cardiovascular disease risk assessment (40.3% vs. 15.1%, P=0.01). There was a moderate correlation between the rheumatologists' number of SLE patients seen and QM performance (rho 0.48, P<0.001).

CONCLUSION

SLE patients seen in dedicated LC had better QM performance in this cross sectional single center study. In our health system, we also found indicators to suggest that rheumatologists with higher SLE patient-volume provide better quality of care. This article is protected by copyright. All rights reserved.