CHICAGO — Patients with high-risk systemic lupus erythematosus have a lower risk for hospitalization and a shorter length of stay as their access to rheumatology care improves, according to data presented by Allen P. Anandarajah, MBBS, of the University of Rochester Medical Center.
“We know that lupus is more common among ethnic minorities and it is also more common in young women,” Anandarajah told attendees at the ACR/ARHP 2018 Annual Meeting. “However, we have also realized that patients who come from poorer economic backgrounds tend to have worse outcomes and higher mortality rates. As clinical director, one of the things I noticed at the hospital was the huge number of admissions among these patients with lupus. So, we began looking at the populations and asked, ‘What are we missing?’ One of the things we found was that access was a huge problem.”
To analyze the impact of interventions to improve access to rheumatology care for high-risk, high-cost patients with SLE, Anandarajah and colleagues at the University of Rochester Medical Center launched IQ-LUPUS (Improve Quality in Low-income, Underserved, Poor, Underprivileged, SLE). This project aimed to improve quality of care for high-risk, high-cost patients with lupus, and increase access to rheumatology care, by connecting them directly with a nurse care coordinator and a social worker. In addition, the medical center opened a rheumatology clinic in a local urban neighborhood, Anandarajah said.
Figure 1. Patients with high-risk SLE have a lower risk for hospitalization as their access to rheumatology care improves, according to data.
A total of 54 patients have to date enrolled in IQ-LUPUS. Researchers compared no-show rates among these patients at the outpatient clinics with those of all other patients with SLE, as well as all rheumatology patients during fiscal year 2017. In addition, the researchers calculated hospitalization rates and lengths of stay for all medical center admissions among those enrolled in the project, comparing these figures for the first 10 months of fiscal year 2017 to the first 10 months of fiscal year 2018.
According to Anandarajah, no-show rates for the enrolled patients were 12.1% in fiscal year 2017, compared to 5.8% for all patients with SLE and 4.3% for all patients seen at the rheumatology clinic. However, no-show rates for the patients in IQ-LUPUS decreased 1.3% in fiscal year 2018 but increased 0.8% for all patients with SLE and 0.7% for all at the rheumatology clinic.
In addition, 16 of the enrolled patients experienced 52 hospital admissions in 2017, for a total length of stay of 231 days. All 16 patients were women, with a mean age of 32.9 years. In 2018, there were 17 enrolled patients with 36 admissions and a total of 159 days spent at the hospital. All of these patients were also women, with a mean age of 32.5 years. The number of 30-day admissions decreased from 21 in 2017 to 14 in 2018.
“This is early data, but it is promising to show that this is something that can improve access,” Anandarajah said. “It is a win-win for both the patients and the hospital. Like I said, this is early data, but I think this shows that improving access has an effect of reducing hospitalization rates.” – by Jason Laday
Disclosure: Anandarajah reports no relevant financial disclosures.
Anandarajah AP. Abstract 1843. Presented at ACR/ARHP Annual Meeting, Oct. 20-24, 2018; Chicago.