Demas Kristina L, Keenan Brendan T, Solomon Daniel H, Yazdany Jinoos, Costenbader Karen H
George Washington School of Medicine, Washington, DC, USA.
Semin Arthritis Rheum. 2010 Dec;40(3):193-200. doi: 10.1016/j.semarthrit.2010.01.001. Epub 2010 Apr 8.
Quality indicators (QIs) for the assessment of care of patients with systemic lupus erythematosus (SLE) have been proposed. We evaluated care according to these proposed QIs for osteoporosis and cardiovascular disease (CVD) in patients with SLE in our rheumatology practice.
We selected 200 patients with SLE according to American College of Rheumatology Criteria and ≥2 visits to our practice in 2007 to 2008. We performed a structured medical record review and collected demographics, SLE and past medical history, medications, laboratories and data concerning osteoporosis, and CVD management. We employed univariable analyses and multivariable regression analyses to test for factors associated with care meeting the proposed QIs.
Ninety-four percent of patients were female and 64% were white. Mean age was 46.3 years and mean lupus duration was 15.3 years. Twenty-nine percent were taking ≥7.5 mg prednisone per day for ≥3 months. The proportions of patients for whom care met the proposed QIs were as follows: 59% for bone mineral density testing, 62% for calcium and vitamin D supplementation, and 86% for antiresorptive or anabolic osteoporosis medications. Only 3% had 5 cardiac risk factors assessed within the year and 26% had 4 cardiac risk factors assessed annually. Smoking, fasting lipid panels, and diabetes mellitus were rarely assessed annually. Having a primary care physician within our health care network increased care meeting QIs.
Care according to newly proposed QIs for osteoporosis and CVD was suboptimal in our academic center. To standardize and improve care of patients with SLE, we suggest specific changes to the proposed QIs.
已提出用于评估系统性红斑狼疮（SLE）患者护理情况的质量指标（QIs）。我们根据这些针对骨质疏松症和心血管疾病（CVD）的拟议QIs，在我们的风湿病科实践中评估了SLE患者的护理情况。
我们根据美国风湿病学会标准，选取了200例SLE患者，这些患者在2007年至2008年期间到我们科室就诊≥2次。我们进行了结构化病历审查，并收集了人口统计学资料、SLE及既往病史、用药情况、实验室检查结果以及有关骨质疏松症和CVD管理的数据。我们采用单变量分析和多变量回归分析来检验与符合拟议QIs的护理相关的因素。
94%的患者为女性，64%为白人。平均年龄为46.3岁，平均狼疮病程为15.3年。29%的患者每天服用≥7.5毫克泼尼松≥3个月。护理符合拟议QIs的患者比例如下：骨密度检测为59%，补充钙和维生素D为62%，抗吸收或促合成骨质疏松药物治疗为86%。一年内仅3%的患者评估了5项心血管危险因素，每年有26%的患者评估了4项心血管危险因素。吸烟、空腹血脂检查和糖尿病很少每年进行评估。在我们的医疗保健网络中有初级保健医生可提高符合QIs的护理水平。
在我们的学术中心，根据新提出的骨质疏松症和CVD的QIs进行的护理并不理想。为了规范和改善SLE患者的护理，我们建议对拟议的QIs进行具体修改。
