Does Higher Quality of Care in Systemic Lupus Erythematosus Improve Quality of Life?

Abstract

Objective To study the association between high quality of care (QOC) and quality of life (QOL) and nonroutine health care use (HCU) in systemic lupus erythematosus. Methods Data were derived from 814 participants from the Lupus Outcomes Study sample. Data on sociodemographic information, disease status, medications, and health care variables were collected through annual interviews. QOC was measured at baseline on 13 quality indices amenable to self‐report. Follow‐up QOL was measured using the Short Form 36 health survey (SF‐36) 2 years later. Univariate and multivariate regression analyses assessed the relationship between QOC and SF‐36 scores at baseline, and logistic regression analyses evaluated QOC at baseline as a predictor of minimal clinically important difference (MCID) improvements in SF‐36 scores, emergency room (ER) visits, and hospitalizations at follow‐up. Results Higher QOC was associated with worse scores on SF‐36 domains on univariate analysis at baseline, which was mediated by comorbidities and high disease activity. QOC and the number of years in high QOC were not predictive of MCID improvements in SF‐36 scores at follow‐up, which were driven by baseline SF‐36 scores, disease activity, and nonroutine HCU. A similar pattern was noted for ER visits and hospitalizations, for which disease activity, damage, and glucocorticoid dose were significant predictors and not QOC. Conclusion High QOC at baseline and the number of years with high QOC are not associated with MCID improvement in SF‐36 scores and nonroutine HCU on follow‐up. High QOC, as determined by currently defined criteria, serves as a surrogate of greater disease activity, morbidity, and nonroutine HCU.

Does higher quality of care in systemic lupus erythematosus translate to better patient outcomes?

“…Notably, at baseline, disease activity was not associated with high QOC (Supplementary table 1) but those receiving high QOC were seen to have high disease activity at follow up which points to the fact that these QIs are probably not sensitive in capturing improvement in disease activity since they focus more on preventive measures. We also collaborated and studied the impact of QOC and high QOC on improvement in QOL on follow up using a generic tool in the LOS cohort from California which has been recently published 21 and found similar findings that QOC or high QOC as measured by these quality indicators (albeit only 13 self-report measures in this study) did not impact the outcome of QOL or non-routine HCU and instead was a surrogate of disease activity and health care interactions.…”

“…The cut off of 80% was selected based on prior analyses by Yazdany et al and our group of studying the impact of high QOC in the Lupus Outcomes Study (LOS) cohort where thresholds of more than 85% and 75%, respectively, were designated as high QOC. 15,21…”

“…The cut off of 80% was selected based on prior analyses by Yazdany et al and our group of studying the impact of high QOC in the Lupus Outcomes Study (LOS) cohort where thresholds of more than 85% and 75%, respectively, were designated as high QOC. 15,21 Outcomes QOL was measured using the LupusPRO, a disease-specific patient reported outcome tool containing 49 items which are grouped under 12 domains measuring health related (HR)-QOL and non (N)-HRQOL. 22 Eight domains: lupus symptoms, lupus medications, physical health, emotional health, pain, sleep, vitality, procreation, cognition, and body image constitute HRQOL and the other four: coping, social support, satisfaction with care, and desires-goals, constitute NHRQOL.…”

Assessing Systemic Lupus Erythematosus Care: Myopic Evaluations and the Elephant in the Room

“…In this issue of Arthritis Care & Research , Arora et al (begin to address this question (4). The authors sought to study the association of receipt of high QOC with QOL and acute‐care utilization (emergency department [ED] visits and hospitalizations) in a cohort of SLE patients.…”