The Importance of Volume
The researchers also looked at the volume of lupus patients seen by a clinician and found a moderate correlation with quality outcomes. “We are eager to further study these quality metrics in other hospitals to see if the results are reproducible,” Dr. Arora says. Eventually, multi-center prospective studies are needed to see if the measured efficiencies translate over time to measured gains in patient health status and health resource utilization.
Beyond just the experience generated by seeing more lupus patients, a rheumatologist who chooses to work in a specialty clinic may have a particular interest in, and desire to know more about, the disease and its treatment. “They are possibly more primed to learn about the condition specifically, and more in tune with the latest scientific developments in the field. Lupus is such a diverse disease that such experience and expertise could give them an edge,” says Dr. Arora.
Specialized lupus clinics also may be able to leverage the subspecialists’ knowledge, experience, care processes and multi-disciplinary networks. Michael Ward, MD, MPH, who works with the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases, previously noted that disease-specific physician volume is associated with lower risk of in-hospital mortality in patients with SLE.5
But if the volume of lupus patients seen at specialty clinics and the resulting greater expertise is key to improved outcomes, could generalist rheumatologists who treat SLE learn from the experts at the specialty clinics? “Our 20 measures have implications for the care of all lupus patients. All rheumatologists could incorporate them into their practice,” Dr. Arora says. “Some are fairly simple, but still important.”
Practicing rheumatologists and primary care physicians seeing lupus patients should be educated on lupus-specific quality measures, she says. They could develop a checklist or another physician-friendly process to use with their lupus patients. In addition, when required and if feasible, primary care physicians and general rheumatologists could consider referring their more complex lupus patients to a specialty clinic.
Larry Beresford is a medical journalist in Oakland, Calif.
References
- Arora S, Nika A, Trupin L, et al. Does systemic lupus erythematosus care provided in a lupus clinic result in higher quality of care than that provided in a general rheumatology clinic? Arthritis Care Res (Hoboken). 2018 Dec;70(12):1771–1777.
- Hochberg MC, for the Diagnostic and Therapeutic Criteria Committee of the American College of Rheumatology. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [letter]. Arthritis Rheum. 1997 Sep;40(9):1725.
- Yazdany J, Panopalis P, Gillis JZ, et al. A quality indicator set for systemic lupus erythematosus. Arthritis Rheum. 2009 Mar;61(3):370–377.
- Yazdany J, Trupin L, Schmajuk G, et al. Quality of care in systemic lupus erythematosus: The association between process and outcome measures in the Lupus Outcome Study. BMJ Qual Saf. 2014 Aug;23(8):659–666.
- Ward MM. Association between physician volume and in-hospital mortality in patients with systemic lupus erythematosus. Arthritis Rheum. 2005 Jun;52(6):1646–1654.
