Are patient ratings of interactions with providers and health plans associated with technical quality of care in systemic lupus erythematosus?
© Yelin et al.; licensee BioMed Central Ltd. 2014
Published: 18 September 2014
Prior research has shown that the technical quality of SLE care is associated with the degree of subsequent accumulated damage. However, it is not known whether the nature of interactions between patients and providers and health systems is associated with the technical quality of care.
We analyzed data from the UCSF Lupus Outcomes Study (LOS), a national sample of persons with SLE interviewed annually using a structured telephone survey. The survey includes batteries from the Consumer Assessment of Health Plans developed by the US Agency for Healthcare Research and Quality and the Interpersonal Processes of Care Scales to rate care along six dimensions about providers (patient-provider communication, shared decision-making, and trust) and health systems (promptness/timeliness of care, care coordination, and assessment of health plans) from 0 to 100. Due to the fact that the ratings were not normally distributed, we dichotomized the measures at the lowest versus the highest three quartiles. The survey also includes the 13 quality indicators (QIs) for SLE that can be reliably reported by patients. The QIs were aggregated into a pass rate, defined as the number of QIs received as a proportion of those for which individuals are eligible. We used generalized estimating equations to model the relationship of the QI pass rate with being in the lowest quartile of ratings of each individual dimension and with being in the lowest quartile on zero, one to three, and four to six of the dimensions. Models were adjusted for age, race/ethnicity, education, poverty status, presence and kind of health insurance, specialty of principal SLE physician, disease duration, disease activity (SLAQ), and disease damage (BILD).
Technical quality of care pass rates by ratings of healthcare experiences in SLE, aggregate
Number of dimensions
QI pass rate (95% CI)
0.71 (0.68, 0.74)
One to three
0.70 (0.67, 0.72)
Four to six
0.63 (0.58, 0.68)
Low ratings on multiple dimensions of interactions may be a sentinel for poor technical quality of care. In the USA, ratings of providers and health plans are in the public domain and this information can help persons with SLE choose providers and health plans more likely to achieve high technical quality of care.
NIAMS Grants P60 AR05308 and R01 AR056476 and Robert Wood Johnson Investigator Award in Health Policy Research.
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