Quality of Care for Patients With Systemic Lupus Erythematosus: Data From the American College of Rheumatology RISE Registry.
Quality of Care for Patients With Systemic Lupus Erythematosus: Data From the American College of Rheumatology RISE Registry.
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DOI：
10.1002/acr.24446
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发表时间：
2022-02
影响因子：
4.7
通讯作者：
Yazdany, Jinoos
中科院分区：
文献类型：
--
作者：
Schmajuk, Gabriela;Li, Jing;Evans, Michael;Anastasiou, Christine;Kay, Julia L.;Yazdany, Jinoos
虽然多个国家的质量措施侧重于类风湿关节炎的管理和安全性，但很少有措施涉及系统性红斑狼疮（SLE）患者的护理。我们的目标是应用一组与SLE患者护理相关的质量指标，我们使用美国流变学学院的流变学信息学有效性系统（RISE）注册表来评估全国范围内的护理差异。数据来自RISE，包括2017 - 2018年≥ 2次访视且SLE代码间隔≥ 30天的患者。我们计算了5项质量指标的表现：肾脏疾病筛查、血压评估和管理、羟氯喹（HCQ）处方、HCQ的安全剂量以及> 7.5 mg/天剂量的糖皮质激素长期使用。我们报告了这些措施在实践层面的表现。在调整了社会人口统计学和利用因素后，我们使用逻辑回归来评估独立的预测因素。我们纳入了来自186家诊所的27，567名独特患者; 91.7%为女性，48%为白色，平均年龄为53.5 ± 15.2岁。很少有患者对肾脏表现的发展进行了充分的筛查（39.5%）。虽然血压评估很常见（94.4%），但有意义的一部分患者患有未经治疗的高血压（17.7%）。许多人接受了HCQ（71.5%），但剂量≤ 5.0 mg/kg/天时仅为62%。一些患者至少接受中等剂量类固醇治疗≥ 90天（18.5%）。我们在每一项措施上都观察到了显著的实践差异。我们发现了美国SLE患者护理的潜在差距。虽然一些性能的变化可以解释疾病严重程度的差异，戏剧性的差异表明，开发质量措施，以解决重要的医疗保健过程中SLE可能会改善护理。
Although multiple national quality measures focus on the management and safety of rheumatoid arthritis, few measures address the care of patients with systemic lupus erythematosus (SLE). Our objective was to apply a group of quality measures relevant to the care of patients with SLE, and we used the American College of Rheumatology’s Rheumatology Informatics System for Effectiveness (RISE) registry to assess nationwide variations in care. The data derived from RISE and included patients who had ≥2 visits with SLE codes ≥30 days apart in 2017–2018. We calculated performance on 5 quality measures: renal disease screening, blood pressure assessment and management, hydroxychloroquine (HCQ) prescribing, safe dosing for HCQ, and prolonged glucocorticoid use at doses of >7.5 mg/day. We reported performance on these measures at the practice level. We used logistic regression to assess independent predictors of performance after adjusting for sociodemographic and utilization factors. We included 27,567 unique patients from 186 practices; 91.7% were female and 48% White, with a mean age of 53.5 ± 15.2 years. Few patients had adequate screening for the development of renal manifestations (39.5%). Although blood pressure assessment was common (94.4%), a meaningful fraction of patients had untreated hypertension (17.7%). Many received HCQ (71.5%), but only 62% at doses of ≤5.0 mg/kg/day. Some received at least moderate-dose steroids for ≥90 days (18.5%). We observed significant practice variation on every measure. We found potential gaps in care for patients with SLE across the US. 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.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
5.4
作者：
Yazdany, Jinoos;Trupin, Laura;Yelin, Edward H.
通讯作者：
Yelin, Edward H.
影响因子：
4.7
作者：
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通讯作者：
Costenbader, Karen H.
影响因子：
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作者：
Marmor, Michael F.;Kellner, Ulrich;Mieler, William F.
通讯作者：
Mieler, William F.
影响因子：
4.7
作者：
Yazdany, Jinoos;Robbins, Mark;Newman, Eric
通讯作者：
Newman, Eric