TY - JOUR
TI - Quality indicators for systemic lupus erythematosus based on the 2019 EULAR recommendations: Development and initial validation in a cohort of 220 patients
AU - Chavatza, K.
AU - Kostopoulou, M.
AU - Nikolopoulos, D.
AU - Gioti, O.
AU - Togia, K.
AU - Andreoli, L.
AU - Aringer, M.
AU - Boletis, J.
AU - Doria, A.
AU - Houssiau, F.A.
AU - Jayne, D.
AU - Mosca, M.
AU - Svenungsson, E.
AU - Tincani, A.
AU - Bertsias, G.
AU - Fanouriakis, A.
AU - Boumpas, D.T.
JO - Annals of the Rheumatic Diseases
PY - 2021
VL - 80
TODO - 9
SP - 1175-1182
PB - BMJ Publishing Group
SN - 0003-4967, 1468-2060
TODO - 10.1136/annrheumdis-2021-220438
TODO - hydroxychloroquine;  prednisone;  acetylsalicylic acid;  antirheumatic agent;  antithrombocytic agent;  dipeptidyl carboxypeptidase inhibitor;  glucocorticoid;  hydroxychloroquine;  immunosuppressive agent;  prednisone, adult;  adverse outcome;  California;  cohort analysis;  disease activity;  disease severity;  drug dose titration;  Europe;  female;  health care organization;  health care quality;  health care system;  hospitalization;  human;  major clinical study;  organ injury;  patient compliance;  remission;  Review;  risk reduction;  systemic lupus erythematosus;  kidney;  lupus erythematosus nephritis;  male;  mass screening;  medical society;  osteoporosis;  pathology;  practice guideline;  preeclampsia;  pregnancy;  protocol compliance;  recurrent disease;  reproducibility;  risk assessment;  systemic lupus erythematosus, Angiotensin-Converting Enzyme Inhibitors;  Antirheumatic Agents;  Aspirin;  Drug Tapering;  Europe;  Female;  Glucocorticoids;  Guideline Adherence;  Hospitalization;  Humans;  Hydroxychloroquine;  Immunosuppressive Agents;  Kidney;  Lupus Erythematosus, Systemic;  Lupus Nephritis;  Male;  Mass Screening;  Osteoporosis;  Platelet Aggregation Inhibitors;  Practice Guidelines as Topic;  Pre-Eclampsia;  Prednisone;  Pregnancy;  Quality Indicators, Health Care;  Remission Induction;  Reproducibility of Results;  Risk Assessment;  Societies, Medical;  Symptom Flare Up
TODO - Quality of care is receiving increased attention in systemic lupus erythematosus (SLE). We developed quality indicators (QIs) for SLE based on the 2019 update of European League Against Rheumatism recommendations. A total of 44 candidate QIs corresponding to diagnosis, monitoring and treatment, were independently rated for validity and feasibility by 12 experts and analysed by a modified Research and Development Corporation/University of California Los Angeles model. Adherence to the final set of QIs and correlation with disease outcomes (flares, hospitalisations and organ damage) was tested in a cohort of 220 SLE patients with a median monitoring of 2 years (IQR 2–4). The panel selected a total of 18 QIs as valid and feasible. On average, SLE patients received 54% (95% CI 52.3% to 56.2%) of recommended care, with adherence ranging from 44.7% (95% CI 40.8% to 48.6%) for diagnosis-related QIs to 84.3% (95% CI 80.6% to 87.5%) for treatment-related QIs. Sustained remission or low disease activity were achieved in 26.8% (95% CI 21.1% to 33.2%). Tapering of prednisone dose to less than 7.5 mg/day was achieved in 93.6% (95% CI 88.2% to 97.0%) while 73.5% (95% CI 66.6% to 79.6%) received the recommended hydroxychloroquine dose. Higher adherence to monitoring-related QIs was associated with reduced risk for a composite adverse outcome (flare, hospitalisation or damage accrual) during the last year of observation (OR 0.97 per 1% adherence rate, 95% CI 0.96 to 0.99). We developed QIs for assessing and improving the care of SLE patients. Initial real-life data suggest face validity, but a variable degree of adherence and a need for further improvement. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
ER -