Relationship Between Process of Care and a Subsequent Increase in Damage in Systemic Lupus Erythematosus

Abstract

Objectives The present study evaluates whether low ratings of interactions with providers and health plans in 2013 were associated with increased SLE damage in 2015. Methods Data derive from the Lupus Outcomes Study (LOS) annual surveys and include items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We use ordinary least squares regression to model the change in disease damage over a two-year period, 2013-2015, as a function of ratings of multiple dimensions of interactions with providers and health plans, with and without adjustment for demographic characteristics, socioeconomic status, and SLE and overall health status, and logistic regression to estimate the effect of the same matrix of variables on the probability of experiencing a minimal clinically important increase in damage. Results There were 566 LOS respondents who were followed from 2013-2015 and who rated their providers and health plans in 2013. After adjustment, persons with SLE rating their providers poorly in patient-provider communication experienced a significantly greater accrual of disease damage (0.23, 95% CI 0.09, 0.38) and were more likely to experience a minimal clinically important increase in damage (OR 2.35, 95%CI 1.25, 4.39). After adjustment, those rating their health plan poorly on care coordination experienced a significantly greater accrual of disease damage (0.19, 95%CI 0.03, 0.35) and were more likely to experience a minimal clinically important increase in damage (OR 2.20, 95%CI 1.12, 4.34). Conclusions Poor patient-provider communication and care coordination may result in increased disease damage.

What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women’s Day

“…The frequency of adverse pregnancy outcomes in women with lupus is 2-fold higher in black and Hispanic women than in white women. In blacks, socioeconomic status was a determinant of pregnancy outcomes and a key contributor to adverse pregnancy outcomes [77, 78]. …”

What we do and do not know about women and kidney diseases – questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

“…Frequency of adverse pregnancy outcomes in women with lupus is 2‐fold higher in black and Hispanic women than in white women. In blacks, socioeconomic status was a determinant of pregnancy outcomes and a key contributor to adverse pregnancy outcomes …”

What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

“…Частота неблагоприятных исходов беременности при СКВ у черных женщин и у жен-щин латиноамериканского происхождения вдвое выше по сравнению с белыми. У черных женщин социоэкономический статус оказался определяю-щим для исходов беременности, внося основной вклад в развитие неблагоприятных исходов [77,78]. РА также поражает преимущественно женщин (соотношение женщин и мужчин 4:1) с пиком за-болеваемости в возрасте 45-55 лет, что совпадает с перименопаузальным периодом.…”