Improving Lupus Care Index Documentation in Patients With Childhood-Onset Systemic Lupus Erythematosus

Authors

Fatima A Barbar-Smiley
Cagri Yildirim-Toruner
Shoghik Akoghlanian
Ohoud AlAhmed
Stacy P Ardoin
Ashlee Leone
Edward Oberle
Vidya Sivaraman

Publication Date

1-1-2024

Journal

Frontiers in Pediatrics

DOI

10.3389/fped.2024.1428644

PMID

39258146

PMCID

PMC11385605

PubMedCentral® Posted Date

8-27-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

childhood lupus, SLE, systemic lupus erythematosus, SLEDAI-2K, PGA, quality improvement

Abstract

INTRODUCTION: Childhood-onset systemic lupus erythematosus (c-SLE) presents unique challenges due to increased risk for severe morbidity and mortality compared to adult-onset SLE. Effective disease management relies on accurate disease assessment and documentation. Our project aimed to improve the documentation of the Lupus Care Index (LCI), a disease assessment bundle, by implementing a quality improvement (QI) initiative.

METHODS: A QI project was conducted at Nationwide Children's Hospital (NCH), targeting patients with c-SLE. The LCI, comprising the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2k) Physician Global Assessment (PGA) and patient-reported pain score, was introduced to capture comprehensive disease assessment. Interventions included provider education, standardization of documentation procedures, and electronic health record (EHR) modifications. Automated reports tracked documentation rates, and Pareto charts identified areas for targeted interventions.

RESULTS: Baseline analysis revealed incomplete documentation of LCI components in only one-third of c-SLE patients. Following interventions, documentation rates improved from 38% to 90%, with sustained improvement over at least a year.

DISCUSSION: Enhancing documentation of LCI in patients with c-SLE is crucial for optimizing disease management. Our quality improvement initiative demonstrated the feasibility of improving documentation practices through targeted interventions and system modifications. Future research should explore the impact of comprehensive documentation on clinical outcomes in pediatric lupus patients. Improving documentation of LCI in patients with c-SLE is essential for optimizing care delivery and clinical outcomes; our QI initiative highlights the effectiveness of systemic interventions in enhancing documentation practices and underscores the importance of continued efforts to improve pediatric lupus care.