Achieving quality of care metrics improves outcomes in pediatric lupus
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Key takeaways:
- Patients with pediatric lupus demonstrate better outcomes when all quality metrics are met.
- Researchers noted that multidisciplinary care models may facilitate delivery of equitable care.
Patients with childhood systemic lupus erythematosus who receive care that closely adheres to quality metrics demonstrate better outcomes, according to data published in Arthritis Care & Research.
“The impetus for this project was really about making the care of our lupus patients better and more holistic,” Joyce C. Chang, MD, MSCE, of the Boston Children's Hospital, and lead author of the study, told Healio. “We had engaged a variety of stakeholders to try and figure out what would be needed to accomplish that. The study presented here is an attempt to measure the potential impact of those changes.”
To evaluate the connection between quality-of-care — in the context of a multidisciplinary care model and provider goal setting — and clinical outcomes, Chang and colleagues conducted a retrospective analysis of a prospective observational database consisting of juvenile patients with SLE and mixed connective tissue disease. Data extraction was performed from December 2018 to July 2022. The researchers implemented electronic health record tools to ensure that patient data were standardized.
The baseline visit was defined as the first visit after EHR tools for standardized data collection were implemented in December 2018. Additionally, index visits for pre-maintenance of certification (MOC) and post-MOC for each patient were defined as the first visits during those periods. Patients were excluded from the analysis if they had fewer than two visits during the observational periods.
The primary outcome for determining the delivery of high-quality care was total score on the 13-item Pediatric Lupus Care Index (p-LuCI), modified to remove influenza vaccination scores and the documentation of adrenal insufficiency. The cutoff score for patients with SLE was 11. For patients with mixed connective tissue disease, it was nine, with each point indicating a metric being met. A patient with SLE with all metrics achieved during care would receive a score of 11/11, or a p-LuCI of 1.0.
The analysis included 110 patients, with a total of 830 rheumatology visits. The researchers reported that a p-LuCI of 0.5 or greater was linked with a 0.72-fold lower risk of prednisone use (95% CI, 0.53-0.93). Patients belonging to underrepresented communities, receiving public insurance and living in areas of “greater social vulnerability” were not linked to reduced care quality or follow-up, according to the researchers. They added that public insurance coverage was associated with greater levels of prednisone use.
“There is evidence to suggest that adherence to care quality metrics might actually improve clinical outcomes,” Chang said. “Population management strategies to ensure timely follow-up are a really important component of that and can promote health equity. We need to move toward multidisciplinary care models as the standard of care for children with lupus, especially those with severe disease or psychosocial needs.”
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