Background/Purpose: Systemic lupus erythematosus is a multisystemic rheumatic disease affecting 1 in 1000 individuals with a 10:1 female predominance. Childhood-onset SLE (CSLE) constitutes approximately 15% of all SLE diagnoses and, when compared to adult-onset disease, CSLE is typically more severe with increased disease and treatment-associated morbidity and mortality. While long term survival of patients with SLE has improved significantly in recent decades morbidity from the disease, itself and its treatment remains an ongoing challenge. Quality indicators (QIs) for SLE have been proposed for adult-onset disease, focused on health maintenance and management of disease- and treatment-related morbidity. These, in turn, may serve as proximate surrogates for longer-term SLE-associated outcomes. The literature reveals that these are performed suboptimally in virtually every clinical setting studied, citing time constraints, forgetfulness, and more pressing issues to address. In efforts to ascertain whether the optimal quality of care is being delivered to these at-risk cSLE patients, and with a view to tailoring Quality Improvement interventions that would be most impactful, we measured the consistency with which five SLE Qis were applied in a young adult transition cohort compared to routine care.

Methods: A comprehensive chart review of all patients attending a young adult SLE transition clinic at a single, tertiary care site was conducted. The three most recent visits were reviewed. Binary data were abstracted from each chart to determine whether there was documentation of sun avoidance counseling, annual influenza vaccine counseling, bone health screening, and anti-malarial-associated ophthalmologic screening, over the visits abstracted. The data were then compared with patients attending the clinics of the two physicians who see the majority of lupus patients at the same institution. Suboptimal adherence was defined as less than 80% in any of the five quality indicators and a difference of < 35% was treated as comparable between the two groups.

Results: A total of 16/57 (28%) patients were counseled regarding sun avoidance. Out of 32 patients on immunosuppressive therapy; 15 (47%) had annual influenza vaccine counseling and none (0/32) received pneumococcal vaccination. Of patients at risk of osteoporosis; 64% underwent BMD testing. Among patients receiving antimalarials; 43/56 (76%) had their eye exam up to date. The comparator group had a comparable rate in sun avoidance counseling (0%), pneumococcal vaccine (12%) and HCQ-associated eye screening (50%) and worse in annual influenza vaccine (20%) and osteoporosis screening (25%).   

Conclusion: The Young Adult Transition Program is adhering suboptimally to the five reviewed QIs, as has been demonstrated in studies at other institutions. Efforts to improve uptake of these QIs will be undertaken, with Quality Improvement interventions driven by the results of a root cause analysis for each QI.  

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/application-of-the-systemic-lupus-erythematosus-sle-quality-indicators-in-patients-attending-a-young-adult-transition-program/