Patients with systemic lupus erythematosus (SLE) more often received care consistent with quality measures when they were seen in a specialized lupus clinic than they did in a general rheumatology clinic, according to results of a recent single-center, retrospective study.
Compared with a general rheumatology clinic, the lupus clinic had superior quality measure performance overall and for specific measures related to testing, treatment, and counseling, study authors reported in Arthritis Care & Research.
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“Providing quality care in SLE is challenging as patients require ongoing, time consuming, multidisciplinary care,” wrote Shilpa Arora, MD, of John H. Stroger Hospital in Chicago, and her coauthors.
Lupus clinics and other disease-focused clinics at academic centers may provide better patient care by leveraging subspecialists’ current knowledge, experience, care processes, and multidisciplinary networks, according to Dr. Arora and her colleagues.
To assess whether a lupus clinic makes any difference in quality of care, Dr. Arora and her coinvestigators conducted a cross-sectional, retrospective chart review including 150 consecutive patients who received care at Rush University in Chicago.
Of that group of patients, 77 had received care in a subspecialty lupus clinic, and 73 received care at the general rheumatology clinic, according to the report.
Looking at validated quality measures for SLE testing, treatment, and counseling, Dr. Arora and her colleagues found performance was significantly greater overall for the lupus clinic than it was for the general rheumatology clinic (85.8% vs. 70.2%; P = 0.001).
In particular, patients treated at the lupus clinic were significantly more likely to get antiphospholipid antibody testing and bone mineral density testing, they said.
Lupus clinic patients were also more likely to be offered preventive measures, such as sunscreen counseling, cardiovascular disease risk assessment, and prescription of an angiotensin converting enzyme inhibitor when appropriate, they added.
To see whether there was any relationship between patient volume and quality measures, the researchers also looked at the number of SLE patients seen by each rheumatologist.
Dr. Arora and her associates did find a moderate correlation between the number of patients seen per rheumatologist and quality measure performance (rho, 0.48; P less than 0.001).
While this small study suggests subspecialty clinics provide high quality care, the authors said multicenter, prospective studies are needed to evaluate whether they also improve patient outcomes.
“It would be pertinent to see if these efficiencies translate over time to measurable gains in health status and health resource utilizations,” Dr. Arora and her colleagues concluded in their report.
Dr. Arora and her associates said there were no relevant financial disclosures or funding.
SOURCE: Arora S et al. Arthritis Care Res (Hoboken). 2018 Apr 2. doi: 10.1002/acr.23569.