Background/Purpose . Prior research has shown that the technical quality of SLE care is associated with the degree of subsequent accumulated damage. However, it is not known whether the patient experience with providers and health systems is associated with the technical quality of care.

Methods . We analyzed data from the UCSF Lupus Outcomes Study (LOS), a national sample of persons with SLE interviewed annually using a structured telephone survey. The survey includes batteries from AHRQ’s Consumer Assessment of Health Plans (CAHPS) and the Interpersonal Processes of Care Scales (IPC) to rate care along six dimensions of patient care experiences with providers (patient-provider communication, shared decision-making, and trust) and health systems (promptness/timeliness of care, care coordination, and assessment of health plans) from 0-100. Because ratings were highly skewed, we dichotomized the measures at the lowest versus the highest three quartiles. The survey also includes the 13 technical quality indicators (QIs) for SLE that have been validated for patient report. The QIs were aggregated into a pass rate, defined as the number of QIs received as a proportion of those for which one is eligible. We used generalized estimating equations to model the relationship of the QI pass rate with being in the lowest quartile of ratings of each individual dimension and with being in the lowest quartile on 0, 1-3, and 4-6 of the dimensions.  Models were adjusted for age, race/ethnicity, education, poverty status, presence and kind of health insurance, specialty of principal SLE physician, disease duration, disease activity (measured by SLAQ), and disease damage (measured by BILD).

Results . 640 LOS participants with ≥1 visit to their principal SLE provider in the year prior to interview were eligible for analysis. Mean age was 52.8±12.6 years and mean disease duration was 20.1±8.8 years. 38% were non-whites and 14% were in poverty. Overall pass rate was .70 (95% CI .68, .71). Being in the lowest quartile of ratings on any one individual dimension was not associated with a statistically significant difference in QI pass rates.  Being in the lowest quartile of ratings on 4-6 dimensions was associated with significantly lower pass rates (.63 vs. .70 and .71 for those in the lowest quartile on 1-3 or 0 dimensions, respectively [Table 1]).

Conclusion .  Consistently low ratings on multiple dimensions of health care experiences may be a sentinel for poor technical quality of care.  Because ratings of providers and health plans are in the public domain, individuals with SLE may find this information useful when choosing where to receive clinical care.