Health care factors affecting outcomes of vulnerable populations with SLE

研究者和其他人之前的工作表明，不同种族/民族和社会经济地位的SLE患者在接受的医疗保健和结果方面存在实质性差异。拟议的项目评估共同构成“保健经验”的三组变量的中介影响。这些问题包括获得适当提供者的机会和适当提供者之间的协调；获得医疗服务后的技术质量；以及护理的人际过程，反映SLE患者和提供者之间的清晰沟通，共同决策，以及支持，尊重和文化上适当的人际风格。

Prior work by the investigators and others has shown that there are substantial differences in the health care received and in outcomes of SLE by race/ethnicity and socioeconomic status. The proposed project assesses the mediating impact of three sets of variables which together constitute "health care experiences". These include access to and coordination among appropriate providers; technical quality of care once access is obtained; and interpersonal processes of care, reflecting clear communication between persons with SLE and providers, shared decision-making, and an interpersonal style that is supportive, respectful, and culturally appropriate. The project will test the effect of these three sets of variables in the context of a theoretical model of health care outcomes. The other major variables incorporated in the model include SLE status as measured by disease activity and damage, structural features of the health care system such as whether care is received in managed care or fee-for-service or in public vs. private insurance, and the nature of the environment, including such characteristics as the extent of poverty in the immediate neighborhood and the availability of health care providers and facilities. The study will use the Lupus Outcomes Study (LOS) to test the model. The LOS participants are diverse in terms of their race/ethnicity, socioeconomic status, duration and severity of SLE, geographic origin, and recruitment source, with over two-thirds sampled outside of clinical environments. The LOS will include about 737 persons with SLE at the outset of the study and over the five-years of follow-up, there will be about 3,300 person-years of observation available for analysis. The specific aims of the study are to describe differences by race/ethnicity and SES in health care experiences, evaluate the role of structural features of the health care system in such health care experiences, and assess the role of health care experiences in outcomes. The project should help clinicians and policymakers better understand how health care results in adverse outcomes of SLE for members of racial and ethnic minorities and those of lower socioeconomic status.