Quality of SLE Care Assessed in Specialized Lupus vs General Rheumatology Clinic

Patients with systemic lupus erythematosus (SLE) who are seen in a dedicated lupus clinic received improved quality of care compared with patients seen at a general rheumatology clinic based on the use of validated SLE quality measures, according to the results of a cross-sectional, single-center, retrospective chart review study published in Arthritis Care & Research.

The investigators sought to compare the quality of care among patients with SLE in 2 different settings at Rush University Medical Center (RUMC) in Chicago, Illinois, using validated SLE quality measures. A total of 150 consecutive patients who received longitudinal care at the general rheumatology clinic at RUMC (n=73) and at the lupus clinic at RUMC (n=77) were recruited for the study. A set of quality measures for SLE care was evaluated using an updated survey and a retrospective medical chart review. Overall and individual quality measure performance was compared between the 2 groups. In addition, data on the number of patients with SLE who were seen by each rheumatologist were compiled to assess the relationship between SLE patient volume and quality measures.

The overall quality measure performance was significantly greater among patients with SLE treated at the lupus clinic vs patients treated at the general rheumatology clinic (85.8% vs 70.2%, respectively; P =.001). Significant differences were noted between the lupus clinic and general rheumatology groups with respect to the following parameters: sunscreen counseling (98.7% vs 83.6%, respectively; P =.001), antiphospholipid antibody testing (71.4% vs 37%; P < .001), pneumococcal vaccination (84.8% vs 48.8%; P <.001), bone mineral density testing (94.2% vs 54.5%; P <.001), drug counseling (92.2% vs 80.8%; P =.04), use of steroid-sparing agents (100% vs 82%; P <.007), use of angiotensin-converting enzyme inhibitors (94.4% vs 58.3%; P =.03), and cardiovascular disease risk assessment (40.3% vs 15.1%; P =.01).

A moderate statistically significant association was reported between the number of patients with SLE seen by a rheumatologist and quality measure performance (P <.001).

The investigators concluded that patients with SLE who were seen in a dedicated lupus clinic exhibited better quality measure performance compared with those seen in a general rheumatology clinic. Indicators also suggested that rheumatologists with higher patient volume offered better quality of care. Larger multicenter, prospective studies are warranted to further elucidate the efficiencies gained when longitudinal SLE care is provided in a subspecialty lupus clinic or by rheumatologists who see a high volume of patients with SLE in their practice.

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Reference

Arora S, Nika A, Trupin L, et al. Does SLE care provided in a lupus clinic result in higher quality of care than general rheumatology clinic? [published online April 2, 2018]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.23569