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

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ACCESS TO RHEUMATOLOGY CARE DECREASES HOSPITALIZATIONS FOR HIGH-RISK LUPUS PATIENTS

Newswise — 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 presenting 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.” 

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About the ACR/ARHP Annual Meeting

The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. With more than 450 sessions and thousands of abstracts, if offers a superior combination of basic science, clinical science, tech-med courses, career enhancement education and interactive discussions on improving patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official #ACR18 hashtag.

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. For more information, visit www.rheumatology.org.

Abstract #: 1843

Improving Access to Rheumatology Care for High-Risk Lupus Patients Can Help Decrease Hospitalizations

Allen P. Anandarajah¹, Sean McMahon², Amanda Ostronic², Changyong Feng³, Jennifer Anolik² and Christopher T. Ritchlin⁴, ¹Univ of Rochester Medical Ctr, Rochester, NY, ²University of Rochester Medical Center, Rochester, NY, ³University of Rochester, Rochester, NY, ⁴Division of Allergy/Immunology and Rheumatology and Center for Musculoskeletal Research, School of Medicine and Dentistry, University of Rochester Medical School, Rochester, New York, USA, Rochester, NY

Background/Purpose: We previously demonstrated that a small group of high risk, high cost patients (HRHC) account for majority of the hospitalizations, length of stay (LOS) and overall cost among all lupus patients admitted to an academic medical center. Herein, we assessed the impact of an intervention to improve access to rheumatology care for HRHC lupus patients by comparing the number of hospital admissions and LOS in the HRHC cohort compared to hospitalized lupus patients not meeting HRHC criteria.

Methods: Lupus patients who required 3 or more admissions over a 3-year period between 2013 and 2016 were categorized as HRHC patients. Most of these patients were from the poor, urban communities and were mostly African American. A project to improve quality for low-income, underprivileged, poor, underage, SLE (IQ-LUPUS) patients was started in July 2018. One of the goals of the IQ-LUPUS project is to enhance access for the HRHC patients to rheumatology care by offering direct access to a nurse care coordinator and a social worker who provide medical advice, remind and facilitate outpatient visits, enable educational activities and organize home visits. Additionally, we opened a clinic in the urban community. We compared the no show rates for the HRHC patients with all lupus patients and all rheumatology patients seen in the outpatient clinics at URMC for the fiscal year (FY) 2017 (prior to project) with FY 2018 (since starting project). We also determined the hospitalization rates and LOS for all admissions among the HRHC patients enrolled in the project, for first 10 months of FY 2017 with the first 10 months of FY 18. The gender, age and the diagnoses on admission were all documented.

Results: A total of 54 HRHC patients are enrolled in the IQ-LUPUS project to date. No show rates for these HRHC patients was 12.1% for FY 2017, 5.8% for all lupus patients and 4.3% for all patients seen at the Rheumatology clinic. The no show rates for the HRHC patients decreased 1.3% for FY 2018 (p=0.62) but increased in all lupus patients (0.8%) and all rheumatology patients (0.7%). In 2017, 16 of the HRHC patients had 52 admissions in 2017 for a total LOS of 231 days. All patients were female with a mean age of 32.9 years. In 2018, the number of admissions decreased to 36 (p=0.3). These admissions included 17 patients and a total LOS of 159 days (p=0.5)). All patients were female with a mean age of 32.5 years. The number of 30-day readmissions also decreased from 21 in 2017 to 14 in 2018. Although no statistical significance was noted early results of the IQ-LUPUS project suggests that improving access can decrease hospitalizations.

Conclusion: Methods aimed at improving access to rheumatology care through care coordination and special clinics can decrease the number of hospitalizations and LOS among high risk SLE patients. Further studies are needed to further define and implement targeted interventions that decrease hospital admissions and improve quality of care for this vulnerable population.

Disclosures: A. P. Anandarajah, None S. McMahon, None A. Ostronic, None C. Feng, None J. Anolik, None C. T. Ritchlin, AbbVie, Amgen, UCB, 2, AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer Inc, 5