PT  - JOURNAL ARTICLE
AU  - Katerina Chavatza
AU  - Myrto Kostopoulou
AU  - Dionysis Nikolopoulos
AU  - Ourania Gioti
AU  - Konstantina Togia
AU  - Laura Andreoli
AU  - Martin Aringer
AU  - John Boletis
AU  - Andrea Doria
AU  - Frederic A Houssiau
AU  - David Jayne
AU  - Marta Mosca
AU  - Elisabet Svenungsson
AU  - Angela Tincani
AU  - George Bertsias
AU  - Antonis Fanouriakis
AU  - Dimitrios T Boumpas
TI  - Quality indicators for systemic lupus erythematosus based on the 2019 EULAR recommendations: development and initial validation in a cohort of 220 patients
AID  - 10.1136/annrheumdis-2021-220438
DP  - 2021 Sep 01
TA  - Annals of the Rheumatic Diseases
PG  - 1175--1182
VI  - 80
IP  - 9
4099  - http://ard.bmj.com/content/80/9/1175.short
4100  - http://ard.bmj.com/content/80/9/1175.full
SO  - Ann Rheum Dis2021 Sep 01; 80
AB  - Background Quality of care is receiving increased attention in systemic lupus erythematosus (SLE). We developed quality indicators (QIs) for SLE based on the 2019 update of European League Against Rheumatism recommendations.Methods A total of 44 candidate QIs corresponding to diagnosis, monitoring and treatment, were independently rated for validity and feasibility by 12 experts and analysed by a modified Research and Development Corporation/University of California Los Angeles model. Adherence to the final set of QIs and correlation with disease outcomes (flares, hospitalisations and organ damage) was tested in a cohort of 220 SLE patients with a median monitoring of 2 years (IQR 2–4).Results The panel selected a total of 18 QIs as valid and feasible. On average, SLE patients received 54% (95% CI 52.3% to 56.2%) of recommended care, with adherence ranging from 44.7% (95% CI 40.8% to 48.6%) for diagnosis-related QIs to 84.3% (95% CI 80.6% to 87.5%) for treatment-related QIs. Sustained remission or low disease activity were achieved in 26.8% (95% CI 21.1% to 33.2%). Tapering of prednisone dose to less than 7.5 mg/day was achieved in 93.6% (95% CI 88.2% to 97.0%) while 73.5% (95% CI 66.6% to 79.6%) received the recommended hydroxychloroquine dose. Higher adherence to monitoring-related QIs was associated with reduced risk for a composite adverse outcome (flare, hospitalisation or damage accrual) during the last year of observation (OR 0.97 per 1% adherence rate, 95% CI 0.96 to 0.99).Conclusion We developed QIs for assessing and improving the care of SLE patients. Initial real-life data suggest face validity, but a variable degree of adherence and a need for further improvement.All data relevant to the study are included in the article or uploaded as online supplemental information.