Medical Research: What is the background for this study? What are the main findings?
Dr. Plantinga: Quality of care for end-stage renal disease (ESRD), which is treated with dialysis or kidney transplantation, is a high priority for the U.S. healthcare system, given universal coverage of these services. However, quality of ESRD care remains relatively unexplored in lupus patients, who have multiple providers and may have greater access to care. We found that, overall, nearly three-quarters of U.S. ESRD patients with lupus had pre-ESRD nephrology care and about 20% of lupus patients on dialysis were waitlisted for kidney transplant per year; however, fewer than one-quarter of those who started on dialysis had a permanent vascular access in place, which is associated with better outcomes than a temporary catheter. Furthermore, patients who were black or Hispanic were nearly a third less likely to have pre-ESRD care and were also less likely to be placed on the kidney transplant waitlist in the first year of dialysis than white patients. Having Medicaid or no insurance at the start of ESRD were both associated with lower likelihood of quality ESRD care by all measures, despite universal Medicare coverage after the start of ESRD. While there was geographic variation in quality of ESRD care, patterns were not consistent across quality measures.
Medical Research: What should clinicians and patients take away from your report?
Dr. Plantinga: Despite multiple national and regional quality-of-care initiatives and incentives aimed at improving care in the overall ESRD population, care for lupus patients with ESRD remains suboptimal, particularly with respect to permanent vascular access placement. Minority patients and those with Medicaid or no insurance—who represent the majority of the young, predominantly female lupus population—were even less likely to access quality care than their white, privately insured counterparts. Better patient-provider, as well as provider-provider communication, could improve quality of ESRD care in this population.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Plantinga: Further study regarding the potential barriers to improving quality of ESRD care in this population at the levels of the health system, ESRD Networks, providers (including rheumatologists, nephrologists, and transplant and vascular access surgeons), and patients is warranted. Our results also identify specific targets for potential intervention studies to improve the translation of quality-of-care measures in this population (particularly, permanent vascular access placement) and the patient subpopulations that are least likely to receive high-quality care.
Sociodemographic and geographic predictors of quality of care in U.S. patients with end-stage renal disease due to lupus nephritis
Laura C. Plantinga, Cristina Drenkard, Rachel Patzer, Mitchel Klein, Michael R. Kramer, Stephen Pastan, S. Sam Lim and William M. McClellan
Accepted manuscript online: Arthritis and Rheumatology 18 FEB 2015 09:53AM EST | DOI: 10.1002/art.38983
MedicalResearch.com Interview with: & Laura Plantinga, PhD Assistant Professor (2015). Minority Patients With Lupus Kidney Disease May Have Suboptimal Care