Advancing Health Equity for Lupus Patients in Wisconsin: How a Care Continuum and Community Stakeholders Can Inform Interventions to Close Disparities Gaps

At a Glance

Gaps in lupus care contribute to higher kidney failure, more early death, and worse lupus damage in U.S. patients who are Black or poor. This project used new data analysis methods to study and identify steps in lupus care with the largest impact on patient health. Health care and patient partners then helped select, adapt, and pilot test strategies to reduce health disparities and improve outcomes.

The Challenge

Lupus is one of the most common autoimmune diseases, causing lifelong burden for 1.5 million U.S. residents and 28,000 Wisconsin residents. Currently, gaps in care for people with lupus contribute to more kidney failure, more cases of early death, and greater disease damage. Notably, in the U.S., those with lupus who are Black suffer greater disease burden when compared to other countries, likely indicating disparities in the U.S. health care system. Research shows that similar care gaps and negative health consequences experienced by people with HIV were reduced by more than 20 percent through targeting key steps in the healthcare process.

Project Goals

The goal of this project was to improve lupus care by identifying modifiable gaps in the lupus care continuum and adapting evidence-based HIV interventions in order to reduce disparities in lupus outcomes.

Results

An analysis of medical records from three Wisconsin health care systems representing diverse populations revealed almost 30 percent higher risk of serious disease damage for those living in areas of greater disadvantage as well as a higher risk of new damage among Black patients with lower hydroxychloroquine (HCQ) adherence. Using national Medicare data, the research team published a new statistical method that uncovered if patients stay in care or stay on HCQ, they most effectively close gaps in medical outcomes. The team convened patients, providers, experts and public health advocates to identify feasible and effective interventions. In collaboration with UW Health, they developed an electronic health record reporting workbench for clinics that allows them to easily identify and reach out to patients with lupus who are missing visits and labs.

Looking to the Future

This work will be expanded through a $2.4 million Department of Defense grant, which seeks to support HCQ adherence and leverage the lupus reporting workbench to include eye screenings.