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Access to Rheumatology Care Decreases Hospitalizations for High-Risk Lupus Patients

CHICAGO – Patients with high-risk systemic lupus erythematosus (SLE) may have a decreased risk of hospitalization and a shorter length of stay when their access to rheumatologic care is improved, according to new research findings presented this week at the 2018 ACR/ARHP Annual Meeting (Abstract #1843).

SLE, also called lupus, is a chronic disease that causes systemic inflammation affecting multiple organs. In addition to affecting the skin and joints, it can affect other organs in the body such as the kidneys, the tissue lining the lungs (pleura), heart (pericardium), and brain. Lupus is far more common in women than men and requires careful management during pregnancy. It is also more prevalent among African-Americans and Hispanics than non-Hispanic whites.

In a previous study, Researchers at the University of Rochester Medical Centerin New York demonstrated that a small group of high risk, high cost patients account for majority of the hospitalizations, length of stay, and overall cost among all lupus patients admitted to an academic medical center. So the researchers decided to conduct a study to assess the impact of interventions to improve access to rheumatology care for these high-risk, high-cost SLE patients.

“In our initial study, we noted that high-risk, high-cost patients (at 45 days) spent three times as many days in the hospital compared to those who were not (at 11 days). We also noted that these were often young women from lower socioeconomic backgrounds,” said Allen P. Anandarajah, MBBS, a rheumatologist at URMC and the study’s lead author. “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.”

The study categorized high-risk, high-cost lupus patients as those who required three or more hospital admissions over a three-year period from 2013 to 2016. Most of the patients in the group were from poor, urban communities and were African-American. In July 2018, University of Rochester Medical Center launched IQ-LUPUS (Improve Quality in Low-income, Underserved, Poor, Underprivileged, SLE), a project to improve quality of care for thehigh-risk, high-costs SLE patients and to enhance patient access to rheumatology care. The program offers direct access to a nurse care coordinator and a social worker. The center also opened a rheumatology clinic in a local urban neighborhood.

The researchers compared the no-show rates for high-risk, high costs patients at the outpatient clinics with those of all other lupus patients as well as all rheumatology patients for the fiscal year 2017.  They also determined hospitalization rates and length of stay for all medical center admissions among the patients enrolled in the project, comparing these figures for the first 10 months of FY2017 to the first 10 months of FY2018. Sex, age and diagnoses on admission were also documented for the patients in the cohort.

To date, 54 patients are enrolled in IQ-LUPUS. No-show rates for the high-risk, high-cost patients were 12.1 percent in FY2017, compared to 5.8 percent for all lupus patients and 4.3 percent for all patients seen at the rheumatology clinic. No-show rates for the high-risk, high-cost patients decreased 1.3 percent in FY2018, but increased in all lupus patients by 0.8 percent and all rheumatology patients by 0.7 percent.

In 2017, 16 high-risk, high-cost patients had 52 hospital admissions and a total length of stay of 231 days. All of these patients were female, with a mean age of 32.9 years. In 2018, there were 17 high-risk, high-cost patients with 36 hospital admissions and a total LOS of 159 days. All of these patients were also female, and their mean age was 32.5 years. The number of 30-day admissions also decreased from 21 in 2017 to 14 in 2018.

“Early results of IQ-LUPUS suggest that improved access to rheumatology care through innovative care coordination and special clinics, can decrease hospitalizations and length of hospital stay for these high-risk, vulnerable patients,” said Dr. Anandarajah.

“Health care disparities in lupus are substantial, and high-risk, high-cost patients are more likely to encounter avoidable admissions, given their frequent use of the health care system. Accountable care organizations and the implementation of value-based payments have increased the need to improve care for these patients and reduce costs. We aim to continue to build trusting relationships with patients and community leaders from low-income neighborhoods through continued interactions in focus group meetings, educational sessions and other programs.”

Monica McDonald
Newsroom: 312-949-8822
Office: 404-633-3777, ext. 332


About the ACR/ARHP Annual Meeting
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About the American College of Rheumatology
The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy, and practice management support to help its members continue their innovative work and provide quality patient care.

Rheumatologists are experts in the diagnosis, management, and treatment of more than 100 different types of arthritis and rheumatic diseases.

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