Identification and Characterization of a High‐Need, High‐Cost Group Among Hospitalized Patients With Systemic Lupus Erythematosus

Abstract

Objective To identify a high‐need, high‐cost (HNHC) group among hospitalized lupus patients and to compare clinical and social factors of the HNHC group with those of other patients with lupus. Methods All hospitalizations for lupus in a tertiary care center over a 3‐year period were recorded. The number of admissions, 30‐day readmissions, length of stay (LOS), and cost of admissions were compared for high‐risk patients with those of all other hospitalized lupus patients (OHLP) during this period. We then compared clinical measures (double‐stranded DNA [dsDNA] levels, complement proteins, body mass index, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI] scores, and Case Mix Index [CMI] scores) for the HNHC cohort with those of the OHLP group. We additionally differentiated social factors (age, race and ethnicity, poverty, and medication adherence) between the 2 groups. Results A total of 202 patients with lupus accounted for 467 hospitalizations over the study period. The total cost of admissions was $13,192,346. Forty‐four patients had significantly higher admissions, 30‐day readmissions, and LOS. Furthermore, the cost for this group was 6‐fold that for the OHLP group, confirming the presence of an HNHC cohort. The HNHC group had significantly higher dsDNA levels, SDI scores, and CMI scores compared with the OHLP group. Infections were the most common cause of admission for both groups. Patients in the HNHC group were more likely to be African American, younger, diagnosed with lupus at an earlier age, to have lower medication adherence, and to be significantly more likely to live in areas of poverty. Conclusion A small group of patients with lupus (the HNHC group) accounts for most of the hospitalizations and cost. The HNHC group has both social and clinical factors significantly different from other patients with lupus.

Analysis of 5-year hospitalization data of patients with systemic lupus erythematosus: Damage is a risk factor for frequent and longer stays

“…19 In another study, it was observed that the mean SDI was higher in SLE patients who needed hospitalization. 20 Similarly, we found less damage in patients hospitalized due to active disease compared to those hospitalized due to damage ( p = .033). Similar to other studies, we found that SDI score showed statistically significant positive correlations with the hospitalization duration for each hospitalization (r = 0.317, p < .001), the total length of hospitalization during the follow-up period (r = 0.551, p < .001), and the total number of hospitalizations (r = 0.393, p < .001).…”

“…Anandarajah et al observed damage the most frequently in the renal (34.7%), neuropsychiatric (22%), and musculoskeletal (20.3%) systems in hospitalized patients. 20 Differently, cardiovascular damage (30.4%) was much more frequent than renal damage (23%); and pulmonary damage (23%) was remarkably high in our study. We supposed that this finding was related to the fact that almost 1/3 of our hospitalized patients had a history of vascular thrombosis with SLE and antiphospholipid syndrome.…”

The Impact of an Integrated Care Management Program on Acute Care Use and Outpatient Appointment Attendance Among High‐Risk Patients With Lupus

“…At our hospital, iCMP nurses act as a liaison between the patient and their PCP, and this enhanced care coordination may have led to less acute care use and more contact with primary care. A recent study found that high-need, high-cost patients with SLE (defined as three or more hospital admissions per year) are more likely than other patients with SLE to be Black, to be younger, to have been diagnosed with SLE at a younger age, to have medication nonadherence, and to reside in highpoverty areas (18). These risk factors are associated with limited resources, inexperience navigating the health care system, and/or mistrust of health care providers (19,20).…”