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Quality of Care for the Screening, Diagnosis, and Management of Lupus Nephritis Across Multiple Health Care Settings
Author(s) -
Aggarwal Ishita,
Li Jing,
Trupin Laura,
Gay Lisa,
Katz Patricia P.,
Lanata Cristina,
Criswell Lindsey,
Murphy Louise B.,
Dall'Era Maria,
Yazdany Jinoos
Publication year - 2020
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23915
Subject(s) - lupus nephritis , medicine , systemic lupus erythematosus , medical record , epidemiology , blood pressure , family medicine , disease , physical therapy
Objective We examined quality measures for screening, diagnosis, and treatment of lupus nephritis ( LN ) among participants of the California Lupus Epidemiology Study across 25 different clinical sites to identify gaps in quality of care. Methods Data from 250 participants with lupus were analyzed across 3 sources (medical records, physician examination, and patient interviews). Overall performance on 8 quality measures was calculated separately for participants with and without LN . We used generalized estimating equations in which the outcome was performance on measures, adjusting for participant demographics, lupus disease severity, and practice characteristics. Results Of 148 patients without LN , 42% underwent screening laboratory tests for nephritis, 38% underwent lupus activity serum studies, and 81% had their blood pressure checked every 6 months. Of 102 LN patients, 67% had a timely kidney biopsy, at least 81% had appropriate treatment, and 78% achieved target blood pressure within 1 year of diagnosis. Overall performance in participants across quality measures was 54% (no LN ) and 80% ( LN ). Significantly higher overall performance for screening measures for LN was seen at academic (63.4–73%) versus community clinics (37.9–38.4%). Similarly, among those with LN , higher performance in academic (84.1–85.2%) versus community clinics (54.8–60.2%) was observed for treatment measures. Conclusion In this quality‐of‐care analysis across 25 diverse clinical settings, we found relatively high performance on measures for management of LN . However, future work should focus on bridging the gaps in lupus quality of care for patients without nephritis, particularly in community settings.