Interactions Between Patients, Providers, and Health Systems and Technical Quality of Care

Authors

  • Edward Yelin,

    Corresponding author
    1. The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
    • University of California, San Francisco, Box 0920, San Francisco, California 94143-0920. E-mail: ed.yelin@ucsf.edu

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  • Jinoos Yazdany,

    1. The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, University of California, San Francisco
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  • Chris Tonner,

    1. The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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  • Laura Trupin,

    1. The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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  • Lindsey A. Criswell,

    1. The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, University of California, San Francisco
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  • Patricia Katz,

    1. The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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  • Gabriela Schmajuk

    1. The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, University of California, San Francisco
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Abstract

Objective

Prior studies have established disparities by race/ethnicity and socioeconomic status (SES) in the kind, quantity, and technical quality of systemic lupus erythematosus (SLE) care and outcomes. In this study we evaluate whether disparities exist in assessments of interactions with health care providers and health plans and whether such interactions affect the technical quality of SLE care.

Methods

Data derive from the Lupus Outcomes Study (LOS). Principal data collection is an annual structured phone interview including items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We use general estimating equations to assess whether disparities exist by race/ethnicity and SES in being in the lowest quartile of ratings of such interactions and whether ratings in the lowest quartile of interactions are associated with technical quality of care after adjustment for sociodemographic and disease characteristics.

Results

In the 2012 LOS interview, there were 793 respondents, of whom 640 had ≥1 visit to their principal SLE provider. Nonwhite race/ethnicity and education were not associated with low ratings on any dimension of provider or system interaction; poverty was associated only with low ratings of health plan interactions. After adjustment for demographics, SLE status, and health care variables, ratings in the lowest quartile on all dimensions were associated with significantly lower technical quality of care.

Conclusion

Ratings in the lowest quartile on all dimensions of interactions with providers and the health care system were associated with lower technical quality of care, potentially resulting in poorer SLE outcomes.

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