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较少，实际的医疗保健利用率较低，部分原因在于其健康保险的性质。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SLE患者获得护理的机会较少和健康结果较差方面所起的作用。该项目将利用狼疮结局研究（LOS）的数据来评估护理质量对狼疮结局的影响。LOS目前包括来自全国不同环境的1026名SLE患者，其中大多数人已经被跟踪了5年。LOS中的主要数据是来自医疗图表和年度结构化电话访谈的数据，辅以来自人口普查和其他公开数据源的关于LOS参与者的社区和医疗市场的背景数据，并通过地理编码与调查答复相匹配。该项目的具体目标是：1)描述SLE护理在多大程度上符合横截面和随时间推移的质量衡量标准；2)建立医疗服务质量与医疗服务利用种类和程度的关系；3)记录不同社会经济地位、种族/民族、当地社区和医疗市场性质的护理质量差异；4)在考虑个人社会经济状况和医疗保健基础设施的程度后，建立医疗保健系统特征之间的关系，如保险类型（医疗补助、医疗保险或私人）、保险形式（管理式医疗或按服务收费）、成本分担程度和医疗质量；以及，5)描述护理质量的差异在解释SES结果差异中所起的作用，包括传统的结果测量和成本。该项目表明，通过帮助SLE患者的医生提供护理或鼓励他们转诊到高质量的医疗机构，遵守护理质量标准可以帮助SLE患者减少可及性和结果上的差异。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，具有潜在的显著发病率。先前的研究已经确定，社会经济背景较低的SLE患者获得护理和长期预后的机会较差。拟议的项目将对1000多名SLE患者进行为期10年的随访，以确定社会经济地位较低的患者较差的结果在多大程度上是因为他们不太可能获得符合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SLE患者，表明转诊到提供高质量护理的医生将减少结果的差异。

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.