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Study shows that when care quality goes down, lupus damage goes up

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According to findings from a recent study, poor patient-provider communication and care coordination result in increased damage in patients with systemic lupus erythematosus (SLE). If you would like to learn more about how to best communicate with your rheumatologist and physician, please visit JointHealth™ Education and take Lesson 1: The Art of communicating with your rheumatologist.

The research, titled “Relationship Between Process of Care and a Subsequent Increase in Damage in Systemic Lupus Erythematosus” was published in Arthritis Care & Research. The team wanted to understand how data from the Lupus Outcome Study could be used to evaluate healthcare interactions and subsequent accumulation of damage by the disease over two years.

Lead author, Edward Yelin, PhD, of the University of California San Francisco, said: “In the present study, we show that ratings of patient-provider communication and care coordination in the lowest quartile in 2013 were associated with a greater level of damage accrual by 2015.”

The team identified the following factors that affected the quality of care for patients with lupus:

  • the characteristics of the healthcare system
  • the type of health insurance coverage the patient has
  • if the patient has ongoing managed care
  • the characteristics of the physician
  • the nature of clinical encounters between patients and their providers
  • the technical quality of care

For the study, researchers evaluated the data from the University San Francisco Lupus Outcomes Study, a study created in 2002 by re-enrolling patients with lupus who had previously participated in a study about genetic risk factors for the disease. Researchers used the American College of Rheumatology criteria to determine disease activity.

Additional data were collected via an annual structured telephone interview survey. Participants had to answer questions regarding the following:

  • sociodemographic characteristics
  • medications
  • physical and mental health
  • healthcare utilization
  • insurance coverage
  • self-reported measures of disease activity
  • self-reported measures of disease damage
  • self-reported measures of quality of care

Patient and provider encounters were evaluated by looking at three provider-related areas: patient-provider communication, shared decision-making, and trust in the provider. The health plan assessments focused on care coordination, promptness/timeliness of care, and general assessment of the plan.

In total, 566 survey respondents were followed from 2013 to 2015. The ratings of their providers and health plans were given in 2013 at the start of the study.

Here are the findings from the study:

  • Patients who rated their providers poorly in patient-provider communication had significantly greater odds of accumulation of disease damage and experiencing a minimum clinically important increase in damage
  • Patients who rated their health plan poorly on care coordination had significantly higher odds of accumulation of disease damage and higher odds of experiencing a minimum clinically important increase in damage

Yelin concluded: “We observed an effect of patient-provider communication and care coordination even after taking the quality of care into account. This suggests that there can be no substitute for training providers to communicate more effectively with persons with SLE and in making the principal provider and health plan for SLE responsible for working with the patient to facilitate access to the wide range of healthcare services needed to provide care for those with this condition.”