Prior work by the investigators and others has shown that there are substantial differences in the health care received and in outcomes of SLE by race/ethnicity and socioeconomic status. The proposed project assesses the mediating impact of three sets of variables which together constitute "health care experiences". These include access to and coordination among appropriate providers;technical quality of care once access is obtained;and interpersonal processes of care, reflecting clear communication between persons with SLE and providers, shared decision-making, and an interpersonal style that is supportive, respectful, and culturally appropriate. The project will test the effect of these three sets of variables in the context of a theoretical model of health care outcomes. The other major variables incorporated in the model include SLE status as measured by disease activity and damage, structural features of the health care system such as whether care is received in managed care or fee-for-service or in public vs. private insurance, and the nature of the environment, including such characteristics as the extent of poverty in the immediate neighborhood and the availability of health care providers and facilities. The study will use the Lupus Outcomes Study (LOS) to test the model. The LOS participants are diverse in terms of their race/ethnicity, socioeconomic status, duration and severity of SLE, geographic origin, and recruitment source, with over two-thirds sampled outside of clinical environments. The LOS will include about 737 persons with SLE at the outset of the study and over the five-years of follow-up, there will be about 3,300 person-years of observation available for analysis.
The specific aims of the study are to describe differences by race/ethnicity and SES in health care experiences, evaluate the role of structural features of the health care system in such health care experiences, and assess the role of health care experiences in outcomes. The project should help clinicians and policymakers better understand how health care results in adverse outcomes of SLE for members of racial and ethnic minorities and those of lower socioeconomic status.

Public Health Relevance

Health care disparities among persons with SLE have long been noted, but relatively little progress in reducing such disparities has been made. The proposed project analyzes the role that three aspects of health care, access to timely and appropriate providers, technical quality of care, and interpersonal processes of care play in giving rise to differences in outcome by race/ethnicity and socioeconomic status and may help in the design of policies to reduce such differences.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Comprehensive Center (P60)
Project #
2P60AR053308-06
Application #
8293904
Study Section
Special Emphasis Panel (ZAR1-KM (M1))
Project Start
Project End
Budget Start
2012-05-11
Budget End
2013-04-30
Support Year
6
Fiscal Year
2012
Total Cost
$115,926
Indirect Cost
$40,893
Name
University of California San Francisco
Department
Type
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Yelin, Edward; Yazdany, Jinoos; Tonner, Chris et al. (2015) Interactions between patients, providers, and health systems and technical quality of care. Arthritis Care Res (Hoboken) 67:417-24
Armstrong, D L; Zidovetzki, R; Alarcón-Riquelme, M E et al. (2014) GWAS identifies novel SLE susceptibility genes and explains the association of the HLA region. Genes Immun 15:347-54
Yazdany, Jinoos; Marafino, Ben J; Dean, Mitzi L et al. (2014) Thirty-day hospital readmissions in systemic lupus erythematosus: predictors and hospital- and state-level variation. Arthritis Rheumatol 66:2828-36
Bernatsky, Sasha; Ramsey-Goldman, Rosalind; Joseph, Lawrence et al. (2014) Lymphoma risk in systemic lupus: effects of disease activity versus treatment. Ann Rheum Dis 73:138-42
Drenkard, C; Yazdany, J; Trupin, L et al. (2014) Validity of a self-administered version of the brief index of lupus damage in a predominantly African American systemic lupus erythematosus cohort. Arthritis Care Res (Hoboken) 66:888-96
Yazdany, Jinoos; Tonner, Chris; Schmajuk, Gabriela et al. (2014) Receipt of glucocorticoid monotherapy among Medicare beneficiaries with rheumatoid arthritis. Arthritis Care Res (Hoboken) 66:1447-55
Lawson, Erica F; Hersh, Aimee O; Trupin, Laura et al. (2014) Educational and vocational outcomes of adults with childhood- and adult-onset systemic lupus erythematosus: nine years of followup. Arthritis Care Res (Hoboken) 66:717-24
Guthridge, Joel M; Lu, Rufei; Sun, Harry et al. (2014) Two functional lupus-associated BLK promoter variants control cell-type- and developmental-stage-specific transcription. Am J Hum Genet 94:586-98
Kaiser, Rachel; Tang, Ling Fung; Taylor, Kimberly E et al. (2014) A polymorphism in TLR2 is associated with arterial thrombosis in a multiethnic population of patients with systemic lupus erythematosus. Arthritis Rheumatol 66:1882-7
Solomon, Daniel H; Tonner, Chris; Lu, Bing et al. (2014) Predictors of stopping and starting disease-modifying antirheumatic drugs for rheumatoid arthritis. Arthritis Care Res (Hoboken) 66:1152-8

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