Quality of Care for the Screening, Diagnosis, and Management of Lupus Nephritis Across Multiple Health Care Settings

Objective We examined quality measures for screening, diagnosis, and treatment of lupus nephritis (LN) among participants of the California Lupus Epidemiology Study across 25 different clinical sites to identify gaps in quality of care. Methods Data from 250 participants with lupus were analyzed across 3 sources (medical records, physician examination, and patient interviews). Overall performance on 8 quality measures was calculated separately for participants with and withoutLN. We used generalized estimating equations in which the outcome was performance on measures, adjusting for participant demographics, lupus disease severity, and practice characteristics. Results Of 148 patients withoutLN, 42% underwent screening laboratory tests for nephritis, 38% underwent lupus activity serum studies, and 81% had their blood pressure checked every 6 months. Of 102LNpatients, 67% had a timely kidney biopsy, at least 81% had appropriate treatment, and 78% achieved target blood pressure within 1 year of diagnosis. Overall performance in participants across quality measures was 54% (noLN) and 80% (LN). Significantly higher overall performance for screening measures forLNwas seen at academic (63.4-73%) versus community clinics (37.9-38.4%). Similarly, among those withLN, higher performance in academic (84.1-85.2%) versus community clinics (54.8-60.2%) was observed for treatment measures. Conclusion In this quality-of-care analysis across 25 diverse clinical settings, we found relatively high performance on measures for management ofLN. However, future work should focus on bridging the gaps in lupus quality of care for patients without nephritis, particularly in community settings.