SLE
Osteoporosis and Cardiovascular Disease Care in Systemic Lupus Erythematosus According to New Quality Indicators

https://doi.org/10.1016/j.semarthrit.2010.01.001Get rights and content

Objectives

Quality indicators (QIs) for the assessment of care of patients with systemic lupus erythematosus (SLE) have been proposed. We evaluated care according to these proposed QIs for osteoporosis and cardiovascular disease (CVD) in patients with SLE in our rheumatology practice.

Methods

We selected 200 patients with SLE according to American College of Rheumatology Criteria and ≥2 visits to our practice in 2007 to 2008. We performed a structured medical record review and collected demographics, SLE and past medical history, medications, laboratories and data concerning osteoporosis, and CVD management. We employed univariable analyses and multivariable regression analyses to test for factors associated with care meeting the proposed QIs.

Results

Ninety-four percent of patients were female and 64% were white. Mean age was 46.3 years and mean lupus duration was 15.3 years. Twenty-nine percent were taking ≥7.5 mg prednisone per day for ≥3 months. The proportions of patients for whom care met the proposed QIs were as follows: 59% for bone mineral density testing, 62% for calcium and vitamin D supplementation, and 86% for antiresorptive or anabolic osteoporosis medications. Only 3% had 5 cardiac risk factors assessed within the year and 26% had 4 cardiac risk factors assessed annually. Smoking, fasting lipid panels, and diabetes mellitus were rarely assessed annually. Having a primary care physician within our health care network increased care meeting QIs.

Conclusions

Care according to newly proposed QIs for osteoporosis and CVD was suboptimal in our academic center. To standardize and improve care of patients with SLE, we suggest specific changes to the proposed QIs.

Section snippets

Patient Population

Of 1759 patients followed for SLE in the Brigham and Women's Hospital Arthritis Center, we identified 867 seen in Brigham and Women's Hospital Arthritis Center from June 2007 to July 2008 who had SLE (≥4 of 11 of the updated 1997 ACR Classification Criteria for SLE (15, 16) previously confirmed by medical record review by board-certified rheumatologists) and ≥2 outpatient visits to the rheumatology clinic in the year before the date of medical record review. The first 200 of these 867 subjects

Results

The demographics of our patient population are shown in Table 2. The mean cumulative dose of prednisone was 2702.5 mg in the 12 months before review, equal to a mean of 7.4 mg/d of prednisone among glucocorticoid users. Seventeen (n = 185 patients) rheumatology attendings and 9 (n = 15 patients) rheumatology fellows at the Brigham and Women's Hospital were involved in the care of these patients. It took 1 full-time reviewer approximately 200 hours to complete the medical record reviews. There

Discussion

In this study of 200 patients with SLE actively followed at our teaching hospital, we assessed care for osteoporosis and CVD management according to newly proposed QI set for care of patients with SLE. Other areas covered in the QI set included SLE diagnosis, general preventive strategies, drug toxicity monitoring, renal disease, and reproductive health QIs. Given the importance of osteoporosis and CVD prevention for patients with SLE and the time it took to review medical records, we focused

Acknowledgments

We are grateful to all the patients in our study. We also thank Bonnie Bermas, MD, Jonathan S. Coblyn, MD, Elena Massarotti, MD, and Peter Schur, MD for their insights and for seeing the lion's share of these patients. Elizabeth Karlson, MD and Lori B. Chibnik, PhD provided much helpful advice on data collection, analysis, and statistical methods. We appreciate the generosity of the Lupus Foundation of New England and Arthritis Foundation of Massachusetts, who awarded a summer student research

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    • Cited by (0)

    Supported by NIH Grants P60 AR047782, K24 AR055989-01, BIRCWH K12 HD051959 (supported by NIMH, NIAID, NICHD, and OD). Ms. Demas was the recipient of a Lupus Foundation or New England/Arthritis Foundation of Massachusetts jointly sponsored summer student award.

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