A Quality Indicator Set for Systemic Lupus Erythematosus

Overview

Journal Arthritis Rheum

Specialty Rheumatology

Date 2009 Feb 28

PMID 19248127

Citations 65

Authors

Jinoos Yazdany

Pantelis Panopalis

Joann Zell Gillis

Gabriela Schmajuk

Catherine H Maclean

David Wofsy

Edward Yelin

Affiliations

Soon will be listed here.

Abstract

Objective: To systematically develop a quality indicator (QI) set for systemic lupus erythematosus (SLE).

Methods: We used a validated process that combined available scientific evidence and expert consensus to develop a QI set for SLE. We extracted 20 candidate indicators from a systematic literature review of clinical practice guidelines pertaining to SLE. An advisory panel revised and augmented these candidate indicators and, through 2 rounds of voting, arrived at 25 QIs. These QIs advanced to the next phase of the project, in which we employed a modification of the RAND/UCLA Appropriateness Method. A systematic review of the literature was performed for each QI, linking the proposed process of care to potential improved health outcomes. After reviewing this scientific evidence, a second interdisciplinary expert panel convened to discuss the evidence and provide final ratings on the validity and feasibility of each QI.

Results: The final expert panel rated 20 QIs as both valid and feasible. Areas covered included diagnosis, general preventive strategies (e.g., vaccinations, sun avoidance counseling, and screening for cardiovascular disease), osteoporosis prevention and treatment, drug toxicity monitoring, renal disease, and reproductive health.

Conclusion: We employed a rigorous multistep approach with systematic literature reviews and 2 expert panels to develop QIs for SLE. This new set of indicators provides an opportunity to assess health care quality in patients with SLE and represents an initial step toward the important goal of improving care in this patient population.

Citing Articles

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Experiences of sexual and reproductive health screening and counseling in the clinical setting among adolescents and young adults with rheumatic disease.

Huynh B, Ott M, Tarvin S Pediatr Rheumatol Online J. 2025; 23(1):5.

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A survey of systemic lupus erythematosus patients' attitudes toward influenza and pneumococcal vaccination in Southwest China.

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Teratogenic medication use associated with favourable odds of contraception counselling in a cohort of women with systemic lupus erythematosus at a large tertiary academic medical centre.

Chandramouli S, Alvarez C, Englund T, Silverstein R, Sheikh S Lupus Sci Med. 2022; 9(1).

PMID: 36418076 PMC: 9685263. DOI: 10.1136/lupus-2022-000823.

References

Brook R, McGlynn E, Shekelle P . Defining and measuring quality of care: a perspective from US researchers. Int J Qual Health Care. 2000; 12(4):281-95. DOI: 10.1093/intqhc/12.4.281. View

Campbell S, Hann M, Hacker J, Durie A, Thapar A, Roland M . Quality assessment for three common conditions in primary care: validity and reliability of review criteria developed by expert panels for angina, asthma and type 2 diabetes. Qual Saf Health Care. 2002; 11(2):125-30. PMC: 1743588. DOI: 10.1136/qhc.11.2.125. View

Maclean C, Saag K, Solomon D, Morton S, Sampsel S, Klippel J . Measuring quality in arthritis care: methods for developing the Arthritis Foundation's quality indicator set. Arthritis Rheum. 2004; 51(2):193-202. DOI: 10.1002/art.20248. View

Odutola J, Ward M . Ethnic and socioeconomic disparities in health among patients with rheumatic disease. Curr Opin Rheumatol. 2005; 17(2):147-52. DOI: 10.1097/01.bor.0000151403.18651.de. View

Kravitz R, Park R, Kahan J . Measuring the clinical consistency of panelists' appropriateness ratings: the case of coronary artery bypass surgery. Health Policy. 1997; 42(2):135-43. DOI: 10.1016/s0168-8510(97)00064-x. View

Karlson E, Daltroy L, Lew R, Wright E, Partridge A, Fossel A . The relationship of socioeconomic status, race, and modifiable risk factors to outcomes in patients with systemic lupus erythematosus. Arthritis Rheum. 1997; 40(1):47-56. DOI: 10.1002/art.1780400108. View

Sutcliffe N, Clarke A, Gordon C, Farewell V, Isenberg D . The association of socio-economic status, race, psychosocial factors and outcome in patients with systemic lupus erythematosus. Rheumatology (Oxford). 1999; 38(11):1130-7. DOI: 10.1093/rheumatology/38.11.1130. View

Bernatsky S, Pineau C, Joseph L, Clarke A . Adherence to ophthalmologic monitoring for antimalarial toxicity in a lupus cohort. J Rheumatol. 2003; 30(8):1756-60. View

Gladman D, Urowitz M, Rahman P, Ibanez D, Tam L . Accrual of organ damage over time in patients with systemic lupus erythematosus. J Rheumatol. 2003; 30(9):1955-9. View

10.

Kravitz R, Laouri M, Kahan J, Guzy P, Sherman T, Hilborne L . Validity of criteria used for detecting underuse of coronary revascularization. JAMA. 1995; 274(8):632-8. View

11.

Mikuls T, Maclean C, Olivieri J, Patino F, Allison J, Farrar J . Quality of care indicators for gout management. Arthritis Rheum. 2004; 50(3):937-43. DOI: 10.1002/art.20102. View

12.

Bernatsky S, Cooper G, Mill C, Ramsey-Goldman R, Clarke A, Pineau C . Cancer screening in patients with systemic lupus erythematosus. J Rheumatol. 2005; 33(1):45-9. View

13.

Becker-Merok A, Nossent H . Damage accumulation in systemic lupus erythematosus and its relation to disease activity and mortality. J Rheumatol. 2006; 33(8):1570-7. View

14.

Shekelle P, Chassin M, Park R . Assessing the predictive validity of the RAND/UCLA appropriateness method criteria for performing carotid endarterectomy. Int J Technol Assess Health Care. 1999; 14(4):707-27. DOI: 10.1017/s0266462300012022. View

15.

Shekelle P, Kahan J, Bernstein S, Leape L, Kamberg C, Park R . The reproducibility of a method to identify the overuse and underuse of medical procedures. N Engl J Med. 1998; 338(26):1888-95. DOI: 10.1056/NEJM199806253382607. View

16.

Friedman A, Alarcon G, McGwin Jr G, Straaton K, Roseman J, Goel N . Systemic lupus erythematosus in three ethnic groups. IV. Factors associated with self-reported functional outcome in a large cohort study. LUMINA Study Group. Lupus in Minority Populations, Nature versus Nurture. Arthritis Care Res. 2000; 12(4):256-66. DOI: 10.1002/1529-0131(199908)12:4<256::aid-art4>3.0.co;2-g. View

17.

Campbell S, Braspenning J, Hutchinson A, Marshall M . Research methods used in developing and applying quality indicators in primary care. BMJ. 2003; 326(7393):816-9. PMC: 1125721. DOI: 10.1136/bmj.326.7393.816. View

18.

Marmor M, Carr R, Easterbrook M, Farjo A, Mieler W . Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: a report by the American Academy of Ophthalmology. Ophthalmology. 2002; 109(7):1377-82. DOI: 10.1016/s0161-6420(02)01168-5. View

19.

Mangione-Smith R, DeCristofaro A, Setodji C, Keesey J, Klein D, Adams J . The quality of ambulatory care delivered to children in the United States. N Engl J Med. 2007; 357(15):1515-23. DOI: 10.1056/NEJMsa064637. View

20.

Ward M, Lotstein D, Bush T, LAMBERT R, Vollenhoven R, Neuwelt C . Psychosocial correlates of morbidity in women with systemic lupus erythematosus. J Rheumatol. 1999; 26(10):2153-8. View