Health Systems, Quality of Care, and Outcomes in SLE

描述(由申请人提供)：先前的研究已经确定，社会经济地位较低的系统性红斑狼疮(SLE)患者获得护理的机会、实际医疗保健利用率和结果都较差，部分原因是他们的医疗保险的性质。拟议的项目将评估护理质量差异在解释为什么来自弱势背景的系统性红斑狼疮患者较少获得护理和较差的健康结果方面所起的作用。该项目将利用狼疮结局研究(LOS)的数据来评估护理质量对SLE结局的影响。LOS目前包括来自全国各种环境的1026名SLE患者，其中大多数人已经接受了五年的跟踪调查。洛杉矶的主要数据是来自医疗图表和年度结构化电话采访的数据，辅之以人口普查和其他可公开获得的数据源提供的关于洛杉矶参与者的社区和医疗市场的上下文数据，并通过地理编码与调查响应相匹配。该项目的具体目标是：1)描述对系统性红斑狼疮的护理在多大程度上遵守质量衡量标准；2)确定护理质量与卫生保健利用的种类和程度之间的关系；3)按社会经济地位、种族/族裔、当地社区和医疗市场的性质记录护理质量的差异；4)在考虑到个人SES和卫生保健基础设施的范围后，建立诸如保险类型(Medicaid、Medicare或私立)、保险形式(管理式保健或服务费)、费用分担程度和保健质量等保健系统特征之间的关系；以及5)描述保健质量差异在解释SES结果差异方面的作用，包括传统的结果和成本衡量标准。该项目可能有助于减少机会和结果的差距，因为它表明，坚持护理质量标准可以帮助SLE弱势患者，无论是协助他们的医生提供这种护理，还是通过鼓励转诊到高质量的提供者。公共卫生相关性：系统性红斑狼疮(SLE)是一种严重的自身免疫性疾病，由于对许多器官系统的影响，有可能导致显着的发病率。先前的研究已经证实，社会经济背景较低的系统性红斑狼疮患者获得护理和长期结果的机会较差。拟议的项目将使用1,000多名系统性红斑狼疮患者的队列，对其进行长达10年的跟踪调查，以确定社会经济地位较低的人较差的结果在多大程度上是因为他们不太可能获得满足最低质量标准的医疗保健。该项目可以帮助来自低社会经济背景的系统性红斑狼疮患者，因为它表明，转介到提供高质量护理的医生那里将减少结果的差异。

DESCRIPTION (provided by applicant): Prior research has firmly established both that persons of lower socioeconomic status with systemic lupus erythematosus (SLE) experience poorer access to care, actual health care utilization, and outcomes due in part to the nature of their health insurance. The proposed project will assess the role that differences in quality of care play in explaining why persons with SLE from disadvantaged backgrounds have less access to care and poorer health outcomes. The project will draw upon the data from the Lupus Outcomes Study (LOS) to assess the effect of quality of care on SLE outcomes. The LOS currently includes 1,026 persons with SLE from a wide range of environments across the nation, most of whom have been followed for five years. The principal data in the LOS are data from medical charts and annual structured telephone interviews, supplemented by contextual data about the neighborhoods and medical markets of LOS participants from the Census and other publicly available data sources, matched to the survey responses by geocoding. The specific goals of the project are to: 1) describe the extent to which care for SLE adheres to measures of quality cross-sectionally and over time; 2) establish the relationship between quality of care and kind and extent of health care utilization; 3) document differences in quality of care by socioeconomic status, race/ethnicity, local communities, and the nature of medical markets; 4) establish the relationship among such features of the health care system as type of insurance (Medicaid, Medicare, or private), form of insurance (managed care or fee-for-service), and extent of cost sharing and quality of care, after taking personal SES and extent of health care infrastructure into account; and, 5) describe the role that differences in quality of care play in explaining outcome differences by SES, including traditional measures of outcome as well as costs. The project may help reduce disparities in access and outcomes by showing that adherence to standards for quality of care can redound to the disadvantaged with SLE either by assisting their physicians to provide such care or by spurring referral to high quality providers. PUBLIC HEALTH RELEVANCE: Systemic lupus erythematosus (SLE) is a severe autoimmune disease with a potential for significant morbidity due to impacts on many organ systems. Prior research has established that persons with SLE from lower socioeconomic backgrounds have poorer access to care and long-term outcomes. The proposed project will use a cohort of over 1,000 persons with SLE followed for up to ten years to determine the extent to which the poorer outcomes of those of low socioeconomic status is because they are less likely to receive health care that meets minimal criteria for quality. The project could help persons with SLE from low socioeconomic backgrounds by showing that referral to physicians providing high quality care will reduce disparities in outcomes.