Background/Purpose: Healthcare quality for systemic lupus erythematosus (SLE) is a modifiable target for improving patient outcomes. Disease-specific subspecialty lupus clinics may offer experienced healthcare professionals, collaborative multidisciplinary teams and streamlined care processes. Superior performance of a subspecialty lupus clinic in the provision of quality care has been shown in the United States, where access to care based on insurance status is a major factor. We aimed to compare quality of care provided in a subspecialty lupus clinic with hospital and private general rheumatology clinics in a universal healthcare setting.

Methods: Patients with SLE (n = 258) were recruited in 2016 from various clinic settings in Australia, including a subspecialty lupus clinic (n = 147), two hospital general rheumatology clinics (n = 56) and two private rheumatology clinics (n = 55). Quality of care was assessed using 31 validated SLE quality indicators (QI) encompassing diagnostic work-up, disease and comorbidities assessment, drug monitoring, preventative care and reproductive health. Data were collected from both medical records and patient questionnaires. Overall QI performance was calculated as a percentage of the number of QIs met relative to the number of eligible QIs for each patient. Individual QI performance was measured as a percentage of the number of patients that met the QI relative to the number of patients eligible. Overall and individual QI performance were compared between the three clinic settings, and multivariable regression performed to adjust for sociodemographic, disease and healthcare factors.

Results: QI performance was generally high across clinic types for diagnostic work-up, comorbidity assessment, lupus nephritis, drug monitoring, prednisolone taper, osteoporosis management and pregnancy QIs. However, median [IQR] overall performance on eligible QIs was higher in the lupus clinic (66.7% [57.1-74.1]) than the hospital general rheumatology (52.7% [47.5-58.1]) and private rheumatology (50.0% [42.9-60.9]) clinics (p < 0.01) and remained significant after multivariable adjustment. The subspecialty lupus clinic significantly outperformed the other clinic settings on eligible individual QIs for disease activity, disease damage, cardiovascular risk factor and drug toxicity assessments, pre-immunosuppression hepatitis and tuberculosis screening, new medication counselling, vaccinations, sun avoidance education and contraception counselling.

Conclusion: SLE patients managed in a subspecialty lupus clinic received higher quality of care compared to hospital and private general rheumatology clinics.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/higher-quality-of-care-for-patients-with-systemic-lupus-erythematosus-in-a-subspecialty-lupus-clinic-a-multi-setting-cross-sectional-study/