Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Effect of Health Insurance and Physician Specialty on Quality of Care for SLE.

Yelin6,  Edward H., Yazdany6,  Jinoos, Trupin6,  Laura, Tonner6,  Chris, Schmajuk3,  Gabriela, Katz5,  Patricia P., Criswell4,  Lindsey A.

McGill University, Montreal, QC, Canada
National Jewish Medical Center, Denver, CO
Stanford University, Palo Alto, CA
UCSF-Box 0500, San Francisco, CA
Univ of CA San Francisco, San Francisco, CA
University of California, San Francisco, San Francisco, CA

Background:

Quality indicators (QIs) describe the extent to which health care meets minimal standards for quality of care. The authors have recently developed 20 QIs for SLE covering diagnosis, general preventive strategies, osteoporosis prevention and treatment, drug toxicity monitoring, renal disease, and reproductive health.1 Of the 20 QIs, we deemed 14 amenable to self-report. The present study evaluates the extent to which health care in a community-based sample of persons with SLE (PWSLE), the Lupus Outcomes Study (LOS), adheres to these 14 QIs as a function of the kind of health insurance and specialty of physicians seen for SLE.

Methods:

In 2009, 814 PWSLE were in the LOS. Principal data collection is an annual structured telephone interview regarding kind of health insurance, specialty of physicians seen, and health services received, including specific medications. Participants vary in their eligibility for the 14 QIs: all are eligible for the QIs related to counseling about sun avoidance and assessment of cardiovascular risk factors while only 1% are eligible for the QI related to treatment of new-onset proliferative lupus nephritis. We report here the overall pass rate, the % of all QIs for which PWSLE are eligible for which they report requisite health care services, as a function of the kind of health care coverage (HMO vs. non-HMO settings in public and private sectors) and combinations of care for SLE by generalists and rheumatologists. We use logistic regression to estimate the impact of type of health insurance and specialists, with and without adjustment for demographics (age, gender, race/ethnicity, education, and poverty status), disease duration and activity as measured by SLAQ, and number of physician visits on the pass rate. In these estimations, each QI for which PWSLE are eligible represents an observation; we account for the correlation among multiple observations of individuals via generalized estimating equations.

Results:

The 814 PWSLE in the LOS were eligible for an average of 5.1 QIs (range 2–12) per person. The overall pass rate was.66 (95% CI.64-.67). The pass rate improved with increasing number of physician visits in the year prior to interview. It was also significantly higher among PWSLE in public sector HMOs than in private sector HMOs or in public and private sector non-HMO settings (Table 1). Those receiving care from generalists and rheumatologists singly or in combination had higher pass rates than those treated by neither. Adjustment had little effect on the results for kind of insurance or specialty of physician.

Conclusions:

Pass rates for QIs vary significantly by kind of health insurance coverage and specialties seen by PWSLE and rise with increases in the number of physician visits, suggesting that aspects of health care amenable to policy changes may improve quality of care for PWSLE.

Table 1. Pass Rates (95% CI) for QIs among PWSLE, by Kind of Insurance and Specialties Seen

 Kind of Insurance
 HMONon-HMO
 PublicPrivatePublicPrivate
Unadjusted.76 (.70, .81).63 (.60, .67).66 (.63, .69).64 (.62, .67)
Adjusted*.74 (.69, .80).64 (.60, .68).66 (.63, .69).65 (.62, .68)
 Types of Physicians Seen in Past Year
 No generalist or rheumatologistRheumatologist onlyGeneralist onlyGeneralist and rheumatologist
Unadjusted.53 (.42, .65).61 (.57, .66).63 (.59, .68).68 (.66, .70)
Adjusted*.57 (.45, .68).64 (.59, .68).62 (.57, .66).67 (.65, .69)
*Adjusted for age, gender, race/ethnicity, education, poverty status, disease activity and duration, #MD visits.

1Yazdany, J, et al. Arthritis Rheum. 2009 61 370–377.

To cite this abstract, please use the following information:
Yelin, Edward H., Yazdany, Jinoos, Trupin, Laura, Tonner, Chris, Schmajuk, Gabriela, Katz, Patricia P., et al; The Effect of Health Insurance and Physician Specialty on Quality of Care for SLE. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :789
DOI: 10.1002/art.28557

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