Background Prior research has shown that the technical quality of SLE care is associated with the degree of subsequent accumulated damage1. However, it is not known whether the nature of interactions between patients and providers and health systems is associated with the technical quality of care.
Objectives We evaluated the relationship between patient ratings of interactions with providers and health systems and the technical quality of care.
Methods We analyzed data from the UCSF Lupus Outcomes Study (LOS), a national sample of persons with SLE interviewed annually by telephone. The survey includes batteries from the Consumer Assessment of Health Plans (CAHPS) developed by the US Agency for Healthcare Research and Quality and the Interpersonal Processes of Care Scales (IPC)2 to rate care along 6 dimensions about providers (patient-provider communication, shared decision-making, trust) and health systems (promptness/timeliness of care, care coordination, assessment of health plans) from 0-100. Because the ratings were not normally distributed, we dichotomized the measures at the lowest versus the highest three quartiles. The survey also includes the 13 quality indicators (QIs) for SLE that can be reliably reported by patients3. The QIs were aggregated into a pass rate, defined as the number of QIs received as a proportion of those for which individuals are eligible. We used generalized estimating equations to model the relationship of the QI pass rate with being in the lowest quartile of ratings of each dimension and with being in the lowest quartile on 0, 1-3, and 4-6 of the dimensions. Models were adjusted for age, race/ethnicity, education, poverty status, presence and kind of health insurance, specialty of principal SLE physician, disease duration, disease activity (SLAQ), and damage (BILD)4.
Results 640 LOS participants with ≥1 visit to their principal SLE provider in the prior year were eligible for analysis. Mean age was 52.8±12.6 years and mean disease duration was 20.1±8.8 years; 38% were non-whites, and 14% were in poverty. Being in the lowest quartile of ratings on any one individual dimension was not associated with a statistically significant difference in QI pass rates (Table 1). Being in the lowest quartile of ratings on 4-6 dimensions was associated with significantly lower pass rates (0.63 vs. 0.71 for those in the lowest quartile on no dimensions, p=0.02; Table 2).
Conclusions Low ratings on multiple dimensions of interactions may be a sentinel for poor technical quality of care. In the US, ratings of providers and health plans are in the public domain and this information can help persons with SLE choose providers and health plans more likely to achieve high technical quality of care.
Yazdany J TL, Katz P, Schmajuk G, Yelin E. Quality of Care Predicts Disease Outcomes among Patients with Systemic Lupus Erythematosus. Arthritis & Rheumatism 2013; 65:S1135
Stewart A, Napoles-Springer A, Perez-Stable E, et al. Interpersonal processes of care in diverse populations. Milbank Quarterly 1999; 77:305-339
Yazdany J, Trupin L, Tonner C, et al. Quality of Care in Systemic Lupus Erythematosus: Application of Quality Measures to Understand Gaps in Care. J Gen Intern Med 2012
Yazdany J, Trupin L, Gansky SA, et al. The Brief index of lupus damage (BILD): A patient-reported measure of damage in SLE. Arthritis Care & Research 2011; 63:1170-1177
Disclosure of Interest : None declared