Quality of Care for Patients With SLE Varies Widely Across the United States

A nationwide look at the care of patients with systemic lupus erythematosus (SLE) has found significant practice variation in 5 quality measures, according to a new study.

“Although multiple national quality measures focus on the management and safety of rheumatoid arthritis, few measures address the care of patients with SLE,” the researchers wrote. “We applied a group of quality measures relevant to the care of SLE patients and used the American College of Rheumatology’s RISE registry to assess nationwide variations in care.”

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Using data from 186 practices across the United States, the researchers evaluated the practice-level performance of 5 quality measures: renal disease screening, blood pressure (BP) assessment and management, hydroxychloroquine prescribing, safe dosing for hydroxychloroquine, and prolonged glucocorticoid use at doses greater than 7.5 mg per day. 

Patients included in the study had had at least 2 visits with SLE codes at least 30 days apart in 2017 or 2018.

Among 27,567 patients (of whom 91.7% were women and 48% were white), 39.5% had received adequate screening for the development of renal manifestations. And while 94.4% had their BP assessed, 17.7%—a “meaningful fraction,” the researchers noted—had untreated hypertension. 

Meanwhile, 71.5% were prescribed hydroxychloroquine, but only 62% were prescribed doses at or below 5 mg/kg per day. Approximately 18.5% of patients were prescribed at least moderate-dose steroids for 90 days or more.

“Although some performance variation may be explained by differences in disease severity, dramatic differences suggest that developing quality measures to address important health care processes in SLE may improve care,” the researchers concluded.

—Jolynn Tumolo

Reference:

Schmajuk G, Li J, Evans M, Anastasiou C, Kay JL, Yazdany J. Quality of care for patients with SLE: data from the American College of Rheumatology’s RISE registry. Arthritis Care Res. Published online September 16, 2020. https://doi.org/10.1002/acr.24446