Higher quality of care fails to improve quality of life in lupus
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Patients with systemic lupus erythematosus who report a high quality of care do not necessarily report meaningful clinical differences in quality of life, according to data published in Arthritis Care & Research.
Rather, high quality of care appears to be an indicator of greater disease activity, morbidity and non-routine health care use, the researchers wrote.
“Our group has previously shown that patients seen in lupus specialty clinics received better [quality of care (QOC)] in comparison to the general rheumatology clinics and demonstrated a volume-outcome relationship,” Shilpa Arora, MD, MS, of Rush University Medical Center, in Chicago, and co-authors wrote. “However, there is a paucity of data on effects of high QOC on other outcomes in SLE such as [quality of life (QOL)] and follow up non-routine health care utilization (HCU); e.g., emergency room (ER) or urgent care visits and hospitalizations.”
To investigate the impact of quality of care on quality of life and the relationship to non-routine healthcare use in patients with SLE over time, Arora and colleagues examined data from the University of California, San Francisco, Lupus Outcomes Study Sample, an observational group of patients with lupus. All 814 included patients had diagnoses confirmed by medical record review, as well as according to the 1997 American College of Rheumatology classification guidelines.
Data for the cohort were collected by annual phone surveys beginning in 2002. The researchers collected information on disease activity, damage, quality of life and other patient-reported outcomes.
The primary outcome was quality of life improvement at the time of follow-up, as measured using the Medical Outcomes Study Short Form 36 (SF-36). The survey measured physical function, role physical, bodily pain, general health, vitality, social function, role emotional and mental health. In addition, the authors defined minimal clinically important differences (MCIDs) using “anchor- and distribution-based methods.” ED visits and hospitalizations were assessed as secondary outcomes.
According to the researchers, patients who reported higher quality of care correlated with worse SF-36 scores. Additionally, higher quality of care scores at baseline and the overall number of years of higher quality of care did not indicate MCID improvements in the SF-36 scores, the authors wrote. Instead, increases in survey scores were driven by baseline scores, disease activity and non-routine health care use.
“Our study using data from a large cohort of SLE patients showed that those with higher disease activity and more health care utilization receive better QOC,” Arora and colleagues wrote. “At baseline, higher QOC was seen to be associated with poor QOL, which was mediated by disease activity and other comorbidities. QOC did not improve QOL or non-routine [health care utilization] at follow-up ; these were driven instead by disease activity and damage.”
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