Care Quality Associated With Improved Outcomes in Pediatric SLE

Greater attention to care quality metrics are associated with improved outcomes in the setting of pediatric-onset systemic lupus erythematosus (SLE), with greater adherence to metrics associated with reduced prednisone use, according to study findings published in Arthritis Care & Research.

In adult SLE, recommended care processes have been associated with improved outcomes; however, in the pediatric setting, there is considerable variation in process completion.

In a retrospective study, patient records from the pediatric-onset SLE research registry were evaluated for completion of care processes and outcomes. Patients with SLE who received care between 2018 and 2022 at the Children’s Hospital of Philadelphia were assessed for completion of the pediatric Lupus Care Index (p-LuCI), which is a composite index of 13 recommended SLE care metrics ranging from 0.0 to 1.0 (a score of 1.0 indicated perfect metric adherence).

The patients were stratified into groups based on receiving care before and during  a Maintenance of Certification (MOC) provider goal-setting activities program.

Both the pre-MOC (n=88) and MOC groups (n=96) had a mean age of 13.4 years at diagnosis; 80% and 82% were girls; 93% and 88% had received treatment with a disease-modifying antirheumatic drug (DMARD); and 31% and 29% had received treatment with prednisone, respectively.

Each patient had a median of 7 visits, for a total of 830 outpatient rheumatology visits and 720 follow-up visits. The median p-LuCI score was 0.7 in the pre-MOC period and 0.8 in the MOC period.

During the MOC period, greater completion rates of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) in the previous year, physican global assessment, target attestation, lupus characteristics, blood pressure, lipids assessed within 2 years, and vitamin D level within the previous year were observed compared with those in the pre-MOC period (all P <.05).

Total p-LuCI score was associated with current prednisone use (adjusted b=0.13; P <.01), a history of lupus nephritis (adjusted b=0.08; P =.01), MOC activity period (adjusted b=0.05; P =.04), and being diagnosed in the previous 6 months (adjusted b=-0.12; P <.01).

Timely outpatient follow-up (<120 days) was associated with Hispanic White or other ethnicity (adjusted [aRR], 1.34; P =.02), recent diagnosis (<6 months; aRR, 1.29; P =.00), current prednisone use (aRR, 1.18; P =.04), and age at baseline (aRR, 0.96; P =.01).

Predictors for subsequent prednisone use included current prednisone use (risk ratio [RR], 9.36; P =.00), history of neurologic manifestations (RR, 1.45; P =.04), Medicaid insurance (RR, 1.42; P <.01), recent diagnosis (RR, 1.40; P =.00), nonuse of the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) instrument (RR, 1.25; P =.02), p-LuCI of 0.5 or higher (RR, 0.72; P =.03), and medium high social vulnerability index (RR, 0.66; P =.01).

The study authors concluded, “In a real-world population of youth with SLE, we demonstrated improvements in delivery of high-quality care associated with provider-directed goal setting activities […] Routine, automated assessment of care processes and disease status can serve as an important means to ensure equitable care delivery and evaluate interventions designed to deliver comprehensive, patient-centered care.”

Disclosures: This research was supported by GSK. Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.