Lupus Damage Goes Up When Care Quality Goes Down

Poor patient-provider communication and care coordination result in increased damage in patients with systemic lupus erythematosus, according to researchers who explored the process of care for these patients.

The researchers evaluated the impact of provider and health plan ratings on future damage for patients with systemic lupus erythematosus in a study published online May 9 in Arthritis Care & Research.

Led by Edward Yelin, PhD, of the University of California-San Francisco, the investigators wanted to better understand how data from the Lupus Outcome Study could be used to evaluate health care interactions and subsequent accrual of damage over two years.

“In the present study, we show that ratings of patient-provider communication and care coordination in the lowest quartile in 2013 were associated with a greater level of damage accrual by 2015,” wrote Yelin and colleagues.

Factors that affect the quality of care for patients with lupus include attributes of the health care system, type of health insurance coverage, whether the patient has ongoing managed care, and physician characteristics. Additional factors that are underexplored but warrant more attention include the nature of clinical encounters between patients and their providers and the technical quality of care.

The study

Data from the University of California-San Francisco Lupus Outcomes Study were evaluated. The study was created in 2002 by re-enrolling patients with systemic lupus erythematosus who had previously participated in a study about genetic risk factors for the disease. The American College of Rheumatology criteria were used to determine systemic lupus erythematosus status.

Data were collected via an annual structured telephone interview survey that included questions about socio-demographic characteristics, medications, physical and mental health, health care utilization, and insurance coverage. In addition, self-reported measures of disease activity, disease damage, and quality of care were collected.

Assessments of patient and provider encounters included three provider-related areas: patient-provider communication, shared decision making, and trust in the provider. The health plan assessments focused on care coordination, promptness/timeliness of care, and general assessment of the plan.

In total, 566 survey respondents were followed from 2013 to 2015. Ratings of their providers and health plans were given in 2013.

Findings

Patients who rated their providers poorly in patient-provider communication had significantly greater odds of accrual of disease damage (odds ratio, 0.23; 95% CI: 0.09–0.38). They also had higher odds of experiencing a minimum clinically important increase in damage (OR, 2.35; 95% CI: 1.25–4.39).

Also, patients who rated their health plan poorly on care coordination had significantly higher odds of accrual of disease damage (OR, 0.19; 95% CI: 0.03–0.35]) and higher odds of experiencing a minimum clinically important increase in damage (OR, 2.20; 95% CI: 1.12–4.34).

“We observed an effect of patient-provider communication and care coordination even after taking the quality of care into account,” wrote Yelin and the study team. “This suggests that there can be no substitute for training providers to communicate more effectively with persons with SLE and in making the principal provider and health plan for SLE responsible for working with the patient to facilitate access to the wide range of health care services needed to provide care for those with this condition.”

Disclosures:

This research was supported by the National Institute of Musculoskeletal and Skin Diseases (grants P60-AR-053308 and 2R01-AR-056476). Dr. Yelin’s work was supported by the Robert Wood Johnson Foundation Investigator Award in Health Policy. Dr. Yazdany’s work was supported by the National Institute of Musculoskeletal and Skin Diseases (grant K23-AR-060259).

References:

Yelin, E., Yazdany, J. and Trupin, L. “Relationship Between Process of Care and a Subsequent Increase in Damage in Systemic Lupus Erythematosus.” Arthritis Care Res (Hoboken). Published online May 9, 2017. doi:10.1002/acr.22977