Quality of care in systemic lupus erythematosus: the association between process and outcome measures in the Lupus Outcomes Study
Quality of care in systemic lupus erythematosus: the association between process and outcome measures in the Lupus Outcomes Study
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DOI：
10.1136/bmjqs-2013-002494
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发表时间：
2014-08-01
影响因子：
5.4
通讯作者：
Yelin, Edward H.
中科院分区：
文献类型：
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作者：
Yazdany, Jinoos;Trupin, Laura;Yelin, Edward H.
目的：虽然系统性红斑狼疮（SLE）的护理质量评估的过程中的措施是可用的，其关系的长期结果还没有被研究。使用前瞻性，纵向队列研究，我们研究了高质量的护理和两个重要的SLE结果，疾病活动和damage.Methods数据来自加州大学弗朗西斯科分校狼疮结局研究之间的关联。从2009年到2013年，参与者被跟踪，回答年度调查。本研究的主要结局是疾病活动和损害的临床意义增加，分别通过系统性狼疮活动问卷（SLAQ）和狼疮损害简明指数（BILD）进行评估。使用多变量回归，我们研究了高性能的13个有效的质量措施（接收>= 85%的质量措施），和疾病的结果之间的关系，调整疾病状态，社会人口特征，医疗服务和随访time.Results的737名参与者有资格平均五个质量措施（SD 2，范围2-12）。分别有155名和162名参与者的SLAQ和BILD有临床意义的增加。在我们的模型中，我们发现质量指标的表现与SLAQ的变化之间没有统计学上的显著关系。然而，接受更高质量的SLE护理显着保护增加疾病损害（调整OR 0.4，95%CI 0.4至0.7），即使调整后的协变量.Discussion在这个以社区为基础的队列，我们第一次说明了一个强有力的联系之间的过程中的护理，定义的SLE质量措施，并随后积累的疾病损害，一个重要的结果。
Objectives Although process measures to assess quality of care in systemic lupus erythematosus (SLE) are available, their relationship to long-term outcomes has not been studied. Using a prospective, longitudinal cohort study, we examined the associations between high-quality care and two important SLE outcomes, disease activity and damage.Methods Data were derived from the University of California, San Francisco Lupus Outcomes Study. Participants were followed from 2009 through 2013, responding to yearly surveys. Primary outcomes in this study were clinically meaningful increases in disease activity and damage, assessed by the Systemic Lupus Activity Questionnaire (SLAQ) and the Brief Index of Lupus Damage (BILD), respectively. Using multivariable regression, we examined the relationship between high performance on 13 validated quality measures (receipt of >= 85% of quality measures), and disease outcomes, adjusting for disease status, sociodemographic characteristics, healthcare services and follow-up time.Results The 737 participants were eligible for a mean of five quality measures (SD 2, range 2-12). There were 155 and 162 participants who had clinically meaningful increases in SLAQ and BILD, respectively. In our models, we found no statistically significant relationship between performance on quality measures and changes in SLAQ. However, receiving higher-quality SLE care was significantly protective against increased disease damage (adjusted OR 0.4, 95% CI 0.4 to 0.7), even after adjusting for covariates.Discussion In this community-based cohort, we illustrate for the first time a strong link between processes of care, defined by SLE quality measures, and the subsequent accumulation of disease damage, an important outcome.