Systemic lupus erythematosus (SLE), or lupus, is a chronic disease that causes systemic inflammation and affects multiple organs, including kidneys, lung, heart, and brain, as well as the skin and joints. The condition is far more common in women than in men, and it is more prevalent among African-Americans and Latinos than non-Hispanic whites. Furthermore, the disease is often diagnosed late or misdiagnosed, and it requires careful management during pregnancy.
Research presented at the annual meeting shows that patients with high-risk SLE may have a decreased risk of hospitalization and shorter length of stay when they have improved access to rheumatologic care.
Previous research from a team at the University of Rochester Medical Center in New York found that a small group of high-risk, high-cost patients account for most hospitalizations, the majority of length of stay, and most overall cost. Specifically, high-risk, high-cost patients spent three times as many days in the hospital, and such patients often were young women from lower socioeconomic backgrounds.
Allen P. Anandarajah, MBBS, the study’s presenting author, said, “These patients often were unable, or unwilling, to come to outpatient clinics. We organized focus group meetings with patients from within the high-risk group and recognized that the lack of easy access was a major impediment to routine clinical care.” Therefore, the researchers decided to evaluate the impact of interventions to improve access to rheumatology care.
The study defined high-risk, high-cost patients with lupus as those who required three or more hospital admissions over a three-year period between 2013 and 2016. Most of the patients were African-Americans from poor, urban communities. The medical center launched a program called IQ-LUPUS (Improve Quality in Low-income, Underserved, Poor, Underprivileged, SLE) to improve quality of care for the target population and to enhance their access to rheumatology care. IQ-LUPUS opened a rheumatology clinic in a local urban neighborhood, and it offers patients direct access to a nurse care coordinator and social worker.
Researchers examined data from fiscal year (FY) 2017 to compare no-show rates for the high-risk, high-cost patients at the outpatient clinic with no-show rates of all other lupus patients, as well as all rheumatology patients systemwide.They also determined hospitalization rates and length of stay for all medical center admissions among study participants, comparing data from the first 10 months of FY 2017 to the first 10 months of FY 2018.
Fifty-four patients enrolled in IQ-LUPUS. In FY 2017, the no-show rate for high-risk, high-cost patients was 12.1% compared with 5.8% for all patients with lupus and 4.3% for all rheumatology patients. The no-show rate for the high-risk, high-cost patients decreased 1.3% in FY 2018 but increased 0.8% in all patients with lupus and 0.7% in all rheumatology patients. Furthermore, hospital admissions and length of stay decreased in the high-risk, high-cost group—from 52 admissions and 231 days to 36 admissions and 159 days. The number of 30-day admissions also decreased from 21 in 2017 to 14 in 2018.
The researchers concluded that improved access to rheumatology care through programs such as IQ-LUPUS can decrease hospitalizations and length of hospital stay for high-risk, vulnerable patients.