The proposed project, 'The Emerging Health Care System and Persons with SLE', has two principal aims: 1) to describe the nature of the health care system used by persons with systemic lupus erythematosus (SLE) as it is evolving, particularly emerging developments in managed care and the effect of those developments on access to specialty services and, 2), to assess the impact of characteristics of that system on their health care utilization and long-term outcomes, especially for those from racial or ethnic minorities and/or from lower socioeconomic status. The data for the project derive from the UCSF Lupus Panel Study, in which about 1,000 persons with SLE will be followed prospectively for five years through annual structured telephone interviews, comprehensive review of medical charts, and analysis of biological material, including existing buccal DNA samples and blood specimens. The project will test a series of models in which medical and demographic characteristics of the persons with SLE (e.g. extent of organ involvement, overall health status, race/ethnicity, socioeconomic status), characteristics of their physicians (e.g. specialty, type of practice, demographics), formal type of health plan (HMO, preferred provider organization, point of service plan, fee-for-service), and characteristics of plan (e.g. limited access to specialists, limited drug formulary) combine to affect health care utilization and outcomes. The models will be tested by multivariate regression techniques. The project should provide information on the impact of managed care among persons with this specific condition prevalent among minority populations and will serve as a sensitive indicator of how members of minority groups with serious chronic conditions are faring in the contemporary health care marketplace.
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