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Development of a Set of Lupus‐Specific, Ambulatory Care–Sensitive, Potentially Preventable Adverse Conditions: A Delphi Consensus Study
Author(s) -
Feldman Candace H.,
Speyer Cameron,
Ashby Rachel,
L. Bermas Bonnie,
Bhattacharyya Shamik,
Chakravarty Eliza,
Everett Brendan,
Ferucci Elizabeth,
Hersh Aimee O.,
Marty Francisco M.,
Merola Joseph F.,
RamseyGoldman Rosalind,
Rovin Brad H.,
Son Mary Beth,
Tarter Laura,
Waikar Sushrut,
Yazdany Jinoos,
Weissman Joel S.,
Costenbader Karen H.
Publication year - 2021
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.24095
Subject(s) - medicine , delphi method , population , intensive care medicine , adverse effect , ambulatory , medline , health care , delphi , family medicine , medical emergency , environmental health , statistics , mathematics , political science , computer science , law , economics , economic growth , operating system
Objective Individuals with systemic lupus erythematosus (SLE) are at high risk for infections and SLE‐ and medication‐related complications. The present study was undertaken to define a set of SLE‐specific adverse outcomes that could be prevented, or their complications minimized, if timely, effective ambulatory care had been received. Methods We used a modified Delphi process beginning with a literature review and key informant interviews to select initial SLE‐specific potentially preventable conditions. We assembled a panel of 16 nationally recognized US‐based experts from 8 subspecialties. Guided by the RAND‐UCLA Appropriateness Method, we held 2 survey rounds with controlled feedback and an interactive webinar to reach consensus regarding preventability and importance on a population level for a set of SLE‐specific adverse conditions. In a final round, the panelists endorsed the potentially preventable conditions. Results Thirty‐five potential conditions were initially proposed; 62 conditions were ultimately considered during the Delphi process. The response rate was 100% for both survey rounds, 88% for the webinar, and 94% for final approval. The 25 SLE‐specific conditions meeting consensus as potentially preventable and important on a population level fell into 4 categories: vaccine‐preventable illnesses (6 conditions), medication‐related complications (8 conditions), reproductive health–related complications (6 conditions), and SLE‐related complications (5 conditions). Conclusion We reached consensus on a diverse set of adverse outcomes relevant to SLE patients that may be preventable if patients receive high‐quality ambulatory care. This set of outcomes may be studied at the health system level to determine how to best allocate resources and improve quality to reduce avoidable outcomes and disparities among those at highest risk.