Table 1.

A comparison of quality indicator sets.

QI category	Yazdany et al. (2009) [17]	Mosca et al. (2011) [19]
Diagnosis	If a patient has a suspected diagnosis of SLE, then an initial work-up should include the following: ANA, CBC with differential, platelet count, serum creatinine and urinalysis If a patient is newly diagnosed with SLE, then the following laboratory tests should be ordered within 6 months of diagnosis: anti-dsDNA, complement levels and antiphospholipid antibodies	If a patient is diagnosed with SLE, then the following autoantibodies should be evaluated at the first evaluation: ANA, anti-dsDNA, anti-Ro, anti-La, anti-RNP, anti-Sm and anti-phospholipid
Disease monitoring	If a patient has had evidence of SLE renal disease (increasing proteinuria, active urinary sediment, a rising creatinine level, or disease activity on renal biopsy) in the past 2 years, then the following should be obtained at 3-month intervals: CBC, serum creatinine, urinalysis with microscopic evaluation and measurement of urine protein using a quantitative assay	If a patient is diagnosed with SLE, then at least every 6 months the rheumatologist should request the following laboratory assessment: CBC, erythrocyte sedimentation rate, albumin, serum creatinine or estimated glomerular filtration rate, urinalysis and protein:creatinine ratio (or 24 h proteinuria), C3 and C4 If a patient is diagnosed with SLE, then the treating physician should assess and record disease activity using a validated index at each visit If a patient is diagnosed with SLE, then the treating physician should assess and record disease damage by the SLICC/ACR damage index annually If a patient is diagnosed with SLE, then he/she should provide an evaluation of quality of life at each visit If a patient is diagnosed with SLE, then the treating physician or a specialized nurse should record the presence of comorbid conditions at each visit
General preventive strategies	If a patient with SLE is on immunosuppressive therapy, then a pneumococcal vaccine should be administered, unless patient refusal or contraindications are noted If a patient with SLE is on immunosuppressive therapy, then an inactivated influenza vaccination should be administered annually, unless patient refusal or contraindications are noted If a patient has SLE, then education about sun avoidance should be documented at least once in the medical record (e.g., wearing protective clothing, applying sunscreens whenever outdoors and avoiding sunbathing)	If a patient is diagnosed with SLE, then the patient’s history of vaccinations should be documented. Patients should be vaccinated against influenza and pneumococcus (preferably without adjuvant), if there are no contraindications to immunization
Osteoporosis	If a patient with SLE has received prednisone (or other glucocorticoid equivalent) ≥7.5 mg/day for ≥3 months, then the patient should have BMD testing documented in the medical record, unless the patient is currently receiving antiresorptive or anabolic therapy If a patient with SLE has received prednisone (or other glucocorticoid equivalent) ≥7.5 mg/ day for ≥3 months, then supplemental calcium and vitamin D should be prescribed or recommended and documented If a patient with SLE has received prednisone (or other glucocorticoid equivalent) ≥7.5 mg/day for ≥1 month, and has a central T score less than or equal to −2.5 or a history of fragility fracture, then the patient should be treated with an antiresorptive or anabolic agent, unless patient refusal or contraindications are noted
Drug monitoring	If a patient is prescribed a new medication for SLE (e.g., NSAIDs, DMARDs or glucocorticoids), then a discussion with the patient about the risks versus benefits of the chosen therapy should be documented If a patient with SLE is newly prescribed an NSAID, DMARD or glucocorticoid, then baseline studies should be documented within an appropriate period of time from the original prescription If a patient with SLE has established treatment with an NSAID, DMARD or glucocorticoid, then monitoring for drug toxicity should be performed If a patient with SLE is taking prednisone (or other steroid equivalent) ≥10 mg for ≥3 months, then an attempt should be made to taper the prednisone, add a steroid-sparing agent or escalate the dose of an existing steroid-sparing agent, unless patient refusal or contraindications are noted	If a patient is diagnosed with SLE and is prescribed high-dose corticosteroids and/or immunosuppressive drugs, then, based on patient’s history, the rheumatologist should consider the evaluation of HCV, HBV and tuberculosis screening and record the results into the clinical chart before starting therapy If a patient is diagnosed with SLE, then the treating physician should assess the presence of drug toxicity at each visit and record the data in the clinical chart. Alternatively, the physician should record the absence of drug toxicity If a patient is diagnosed with SLE and treated with hydroxycloroquine/chloroquine, then he/she should undergo an ophthalmologic assessment according with the existing guidelines and this should be documented in the clinical chart If a patient is diagnosed with SLE and treated with corticosteroids, then he/she should undergo an ophthalmologic assessment for the presence of cataracts and/or glaucoma according with the existing guidelines. This should be documented in the clinical chart
Management of renal disease	If a patient is diagnosed with proliferative SLE nephritis (WHO or ISN/RPS class III or IV), then therapy with corticosteroids combined with another immunosuppressant agent should be provided and documented within 1 month of this diagnosis, unless patient refusal or contraindications are noted If a patient with SLE has renal disease (proteinuria ≥300 mg/day or estimated glomerular filtration rate <60 ml/min) and ≥2 BP readings, including the last reading, with systolic BP >130 mmHg or diastolic BP >80 mmHg over 3 months, then pharmacologic therapy for hypertension should be initiated or the current regimen should be changed or escalated, unless patient refusal or contraindications are noted If a patient with SLE has proteinuria ≥300 mg/day, then the patient should be treated with an ACE inhibitor or ARB, unless patient refusal or contraindications are noted
Cardiovascular disease	If a patient has SLE, then risk factors for cardiovascular disease, including smoking status, BP, BMI, diabetes and serum lipids (including total cholesterol, HDL, LDL and triglycerides), should be evaluated annually
Reproductive health	If a patient with SLE is pregnant, then anti-SSA, anti-SSB and antiphospholipid antibodies should be documented in the medical record If a patient has had pregnancy complications as a result of APS, then the patient should be offered aspirin and heparin (i.e., heparin or low-molecular-weight heparin) during subsequent pregnancies If a woman between 18 and 45 years of age is started on any of the following medications for SLE: chloroquine, quinacrine, methotrexate, azathioprine, leflunomide, mycophenolate mofetil, cyclosporine, cyclophosphamide or thalidomide, then a discussion with the patient about the potential teratogenic risks of therapy and about contraception should be documented prior to drug initiation, unless the patient is unable to conceive (e.g., has had a hysterectomy, oophorectomy, tubal ligation or is postmenopausal)

ACE: Angiotensin-converting enzyme; ACR: American College of Rheumatology; ANA: Antinuclear antibody; anti-RNP: Anti-ribonucleoprotein; anti-Sm: Anti-Smith; APS: Antiphospholipid syndrome; ARB: Angiotensin receptor blocker; BMD: Bone mineral density; BP: Blood pressure; CBC: Complete blood count; DMARD: Disease-modifying antirheumatic drug; HBV: Hepatitis B virus; HCV: Hepatitis C virus; ISN: International Society of Nephrology; QI: Quality indicator; RPS: Renal Pathology Society; SLE: Systemic lupus erythematosus; SLICC: Systemic Lupus International Collaborating Clinics; SSA: Anti-ssA antibody; SSB: Anti-ssB antibody.