Skip to main content

Table 3 Per-QI performance according to clinic setting

From: Association of clinic setting with quality indicator performance in systemic lupus erythematosus: a cross-sectional study

Quality indicator

SLC

N (%)

HRC

N (%)

PRC

N (%)

p value

Diagnostic work-up

 Suspected diagnosis work-up (US)

50/50

(100.0%)

56/56

(100.0%)

55/55

(100.0%)

–

 New diagnosis tests (US)

50/50

(100.0%)

56/56

(100.0%)

50/55

(90.9%)

0.007

 Autoantibodies at diagnosis (EU)

50/50

(100.0%)

56/56

(100.0%)

54/55

(98.2%)

0.38

Disease and comorbidities assessment

 Assessment of disease activity at each visit (EU)

147/147

(100.0%)

0/56

(0.0%)

0 /55

(0.0%)

<0.001

 Assessment of disease damage at each visit (EU)

141/147

(95.9%)

0/56

(0.0%)

0/55

(0.0%)

<0.001

 Evaluation of quality of life at each visit (EU)

0/147

(0.0%)

0/56

(0.0%)

0/55

(0.0%)

–

 Record comorbidities at least once a year (EU)

147/147

(100.0%)

52/56

(92.9%)

50/55

(90.9%)

0.002

 Monitoring tests every six months (EU)

132/147

(89.8%)

54/56

(96.4%)

22/55

(40.0%)

<0.001

 Assessment of cardiovascular risk factors (US)

91/147

(61.9%)

14/56

(25.0%)

8/55

(14.6%)

<0.001

 Three monthly tests if evidence of renal disease (US)

43/44

(97.7%)

15/16

(93.8%)

2/2

(100.0%)

0.50

 Treatment within one month of diagnosis of proliferative lupus nephritis (US)

43/43

(100.0%)

12/12

(100.0%)

3/3

(100.0%)

–

 Anti-hypertensive treatment in lupus renal disease (US)

22/22

(100.0%)

5/5

(100.0%)

–

–

 ACEI/ARB treatment if proteinuria (US)

42/44

(95.5%)

7/10

(70.0%)

–

0.01

Medications

 Assessment for drug toxicity at each visit (EU)

141/147

(95.9%)

43/56

(76.8%)

44/54

(81.5%)

<0.001

 Ophthalmologic review if on hydroxychloroquine as per guidelines (EU)

46/103

(44.7%)

11/34

(32.4%)

27/38

(71.1%)

0.003

 Ophthalmologic review if on glucocorticoids as per guidelines (EU)

34/67

(50.8%)

5/22

(22.7%)

16/23

(69.6%)

0.007

 Hepatitis B and C and tuberculosis testing prior to starting immunosuppression (EU)

59/95

(62.1%)

19/41

(46.3%)

9/28

(32.1%)

0.01

 Counselling when prescribed new medications (US)

118/139

(84.9%)

14/48

(29.2%)

26/44

(59.1%)

<0.001

 Baseline studies when prescribed new medications (US)

139/139

(100.0%)

45/45

(100.0%)

44/44

(100.0%)

–

 Monitoring tests for established medications (US)

143/145

(98.6%)

51/51

(100.0%)

50/52

(96.1%)

0.28

 Attempt to taper prednisolone if >10 mg for >3 months (US)

75/75

(100.0%)

22/22

(100.0%)

15/15

(100.0%)

–

 Bone mineral density testing if received prednisolone >7.5 mg for >3 months (US)

100/106

(94.3%)

30/31

(96.8%)

18/23

(78.3%)

0.02

 Calcium and vitamin D if received prednisolone >7.5 mg for >3 months (US)

93/105

(88.6%)

27/31

(87.1%)

22/24

(91.7%)

0.86

 Osteoporosis treatment (US)

18/20

(90.0%)

11/12

(91.7%)

9/9

(100.0%)

0.63

Preventative care

 All patients should be vaccinated against influenza and pneumococcus (EU)

34/147

(23.1%)

1/55

(1.8%)

2/55

(3.6%)

<0.001

 Influenza vaccination if on immunosuppressants (US)

64/96

(66.7%)

5/46

(10.9%)

2/36

(5.6%)

<0.001

 Pneumococcal vaccination if on immunosuppressants (US)

21/96

(21.9%)

1/46

(2.2%)

1/34

(2.9%)

<0.001

 Sun avoidance counselling ever (US)

27/147

(18.4%)

5/56

(8.9%)

2/55

(3.6%)

0.01

Reproductive health

 Ro, La and antiphospholipid antibody testing in pregnancy (US)

14/14

(100.0%)

6/6

(100.0%)

5/5

(100.0%)

–

 Aspirin and heparin offered for subsequent pregnancies if antiphospholipid syndrome pregnancy complications (US)

2/2

(100.0%)

2/2

(100.0%)

2/2

(100.0%)

–

 Teratogenic medication risk and contraception counselling in reproductive age women (US)

42/64

(65.6%)

4/20

(20.0%)

6/14

(42.9%)

0.001

  1. Bold: high performance with pass rate >85% of eligible patients
  2. Abbreviations: EU European, HRC Hospital general rheumatology clinic, PRC Private rheumatology clinic, SLC Subspecialty lupus clinic, US United States