Want to improve lupus outcomes? Improve access to rheumatology care, study suggests

By Liz Meszaros, MDLinx
Published November 16, 2018

Key Takeaways

Improved access to rheumatologic care could decrease the risks of hospitalization and shorten hospital lengths of stay (LOS) in patients with high-risk systemic lupus erythematosus (SLE), according to study results presented at the 2018 ACR/ARHP annual meeting, held in October in Chicago, IL.

Researchers had previously shown that, among all lupus patients admitted to an academic medical center, a small group of high-risk, high-cost (HRHC) patients accounted for most of the hospitalizations, LOS, and overall costs.

“In our initial study, we noted that HRHC 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 lead author Allen P. Anandarajah, MBBS, rheumatologist, University of Rochester Medical Center, Rochester, NY. “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.”

In this study, Anandarajah and colleagues studied the effects of improved patient access to rheumatology care in these patients. They categorized lupus patients who required three or more admissions over a 3-year period as HRHC patients. Most were African Americans, and from poor, urban communities.

The Improve Quality in Low-income, Underserved, Poor, Underprivileged SLE (IQ-LUPUS) project was begun in the summer of 2018 to improve access to rheumatology care for these patients through offering direct access to a nurse care coordinator and a social worker.

These professionals provided patients with medical advice, and reminded and smoothed the way for outpatient visits, implemented educational activities, and organized home visits. A clinic in the urban community was also opened as part of the project.

In all, 54 HRHC patients were enrolled. No-show rates for these HRHC patients were significantly higher compared with all lupus patients and all lupus patients seen at the rheumatology clinic (12.1% vs 5.8% vs 4.3%, respectively). After implementation of the IQ-LUPUS project, however, no-show rates for HRHC patients decreased by 1.3% (P=0.62), while those in the other two patient groups increased (0.8% and 0.7%).

In the year prior to the implementation of IQ-LUPUS, 16 of the HRHC patients had 52 hospital admissions, and a total LOS of 231 days. This decreased to 36 admissions in 2018 (P=0.3) in only 17 patients, with a total LOS of 159 days (P=0.5). Anandarajah and colleagues also observed a decrease in 30-day readmissions in HRHC patients, from 21 to 14.

While none of these decreases reached statistical significance, the results are promising.

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

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