Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Assessing Care Using New Quality Indicators for Osteoporosis and Cardiovascular Disease Management in SLE

Demas1,  Kristina, Keenan2,  Brendan T., Solomon3,  Daniel H., Yazdany4,  J., Costenbader3,  K. H.

George Washington University School of Medicine, Washington, DC
Brigham and Women's Hospital, Boston, MA
Brigham & Women's Hospital, Boston, MA
UCSF, SF, CA

Purpose:

Quality indicators (QIs) for assessment of health care quality in SLE have been proposed (Table 1). We aimed to assess quality of care for osteoporosis (OP) and cardiovascular disease (CVD) among SLE patients at our institution.

Table 1. SLE Quality Indicators (Yazdany et al, A&R 2009; 61:370)

I. Osteoporosis
A. IF SLE patient has received prednisone >=7.5 mg/d for >=3 mo, THEN patient should have BMD testing recorded in medical record*, unless patient is c receiving anti-resorptive** or anabolic therapy.
B. IF SLE patient with SLE has received prednisone >=7.5 mg/d for >=3 mo, THEN should receive calcium + vitamin D.
C. IF SLE patient has received prednisone >=7.5 mg/d for >=1 mo, and has t-score <=-2.5 or fragility fracture, THEN should receive anti-resorptive/anabolic agent.
II. CVD
For all SLE patients, CVD risk factors (smoking, blood pressure, BMI, diabetes, slipids) should be documented annually.
*The interval for BMD testing was increased to 24 months in place of 18 months as recommended by the panel due to common health insurance restrictions.
**Anti-resorptive/bisphosphonate medications included risedronate, pamidronate, ibandronate, etidronate, zolendronate, alendronate, raloxifene, any hormone replacement therapy (Prempro, estrogen) and miacalcin.
†Anabolic agents included parathyroid hormone.

Method:

We randomly identified 200 patients meeting ACR Criteria for SLE Classification, with >= 2 visits to our academic rheumatology practice in 2007–8. We performed a structured electronic medical record review of rheumatologists' notes, medical history, medications, laboratories and bone mineral density (BMD) results. We assessed adherence with proposed SLE QIs for OP and CVD.

Results:

94% of patients were female; 64% were white, mean age was 46.3 years (SD 14.1), mean SLE duration was 15.3 years (SD 11.1). 29% received >=7.5 mg prednisone/day for >=3 months during the year. 57% had received indicated BMD, 62% indicated calcium + vitamin D, and 86% indicated anti-resorptive/anabolic agents. 26% had >=4 and 60% had >=3 CVD risk factors documented in the year. Only 3%, all current smokers, had smoking status documented. Having a primary care physician within our healthcare network was a significant predictor of documented QI adherence (p=0.03 for indicated BMD and p <0.01 for CVD risk factor documentation).

Conclusion:

Documented compliance with newly proposed QIs for OP and CVD in SLE was sub-optimal in our center. We found opportunities for improvement in academic rheumatologists' care, and for revisions of proposed QIs to capture the most meaningful clinical data.

To cite this abstract, please use the following information:
Demas, Kristina, Keenan, Brendan T., Solomon, Daniel H., Yazdany, J., Costenbader, K. H.; Assessing Care Using New Quality Indicators for Osteoporosis and Cardiovascular Disease Management in SLE [abstract]. Arthritis Rheum 2009;60 Suppl 10 :312
DOI: 10.1002/art.25395

Abstract Supplement

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