Background/Purpose: In 2012, the ACR released guidelines for monitoring and treatment of lupus nephritis (LN), but studies have yet to evaluate adherence to these recommendations. Using measures from the SLE Quality Indicators Project (Yazdany, et al., 2009) and new measures derived from ACR guidelines, we evaluated quality of care for LN among patients enrolled in the California Lupus Epidemiology Study (CLUES), a multi-ethnic, population-based cohort study.

Methods: We reviewed charts of CLUES patients to evaluate performance on quality measures (N=116 of 281 enrolled in the study to date). Patients were followed either in tertiary academic centers or by community rheumatologists in the study catchment area. Seven quality measures were assessed. For those without LN, we evaluated whether recommended screening processes were completed in the year preceding study enrollment (2014-2016) (urinalysis, urine protein: creatinine ratio and serum creatinine checked every 6 months; C3/C4 and anti-dsDNA levels every 6 months; and blood pressure checked every 3 months). For those with prevalent LN, we looked to see if patients had a renal biopsy at the time of diagnosis, received an immunosuppressant within 30 days of LN diagnosis, and were started on an ACEi/ARB and anti-malarial therapy within 1 year. “Pass rates” (% eligible patients receiving recommended care) for these measures were analyzed for the entire group and compared for tertiary vs community treatment settings using chi-squared tests.

Results: Among the 116 patients, 55 had a diagnosis of LN. 75 were followed in tertiary care settings and 41 by community rheumatologists. For patients with no history of LN, 40% had recommended screening of urine and renal function every 6 months, and 45% had screening for immunological activity every 6 months (Table). Adherence to blood pressure checks every 3 months was better (74%). For patients with LN, most patients (87%) had renal biopsies for diagnostic confirmation and 82% were started on an immunosuppressant within 1 month of diagnosis. 80% were placed on an anti-malarial and 68% on a renal protective antihypertensive (ACEi or ARB) within 1 year of diagnosis. We found no differences between community and tertiary care settings in measures assessing the diagnosis and treatment of LN. However, performance on measures examining screening of urine, renal function, immunological activity, and BP for patients with no history of LN was lower among community rheumatologists (see Table).

Conclusion: We found relatively high performance on quality measures regarding LN diagnosis and treatment, with no differences between community and tertiary care settings. For patients with no history of LN, we found that screening for renal disease was performed less in community settings. Next steps include reviewing additional records from CLUES and validating our chart review procedures across health care settings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/application-of-lupus-nephritis-quality-measures-to-understand-gaps-in-care-for-sle/