Persistently Frequent Emergency Department Utilization Among Persons With Systemic Lupus Erythematosus

Abstract

Objective. In order to identify opportunities to improve outpatient care, we evaluated patients with systemic lupus erythematosus (SLE) who persistently frequent the emergency department (ED).Methods. We conducted a retrospective study of patients with SLE who frequented the ED for ≥3 visits in a calendar year, from 2013 to 2016. Persistent users were those who met criteria for persistent use for at least 2 of the 4 years, and limited users for 1 of the 4 years. Each ED encounter was categorized as SLE-related, infection-related, pain-related, or other. We compared ED use between persistent and limited users, and analyzed factors associated with pain-related encounters among persistent users through multivariate logistic regression.Results. We identified 77 participants who had 1,143 encounters as persistent users, and 52 participants who had 335 encounters as limited users. Persistent users accounted for 77% of ED use by patients with SLE who frequented the ED. Pain-related ED visits were more common among persistent users (32%) than limited users (18%). Among persistent users, most pain-related encounters were discharged from the ED (69%) or within 48 hours of admission (20%). Persistent users with pain-related encounters accounting for >10% of ED use were more likely to be obese, have fewer comorbid conditions, and be on long-term opioid therapy.Conclusion. Pain is a major cause of ED use. Patients with SLE who persistently utilize the ED for pain are likely to be noncritically ill, as evidenced by frequent discharges from the ED and short-stay admissions. Patients with SLE who persistently frequent the ED for pain represent a viable target for interventions to improve outpatient quality of care.

Persistent frequent emergency department users with chronic conditions: A population-based cohort study

“…The variables associated with persistent frequent use found in this study were all reported by previous studies [32,33,35,36], while some studied both occasional frequent use and persistent frequent use [32,33,36]. In those same studies, depending on the studied population, some specific diagnoses were also associated with persistent frequent use, such as COPD diagnosis.…”

“…In those same studies, depending on the studied population, some specific diagnoses were also associated with persistent frequent use, such as COPD diagnosis. Besides, a few studies mentioned race [32,33] and deprivation indices [32,35,36] as significant, though those latter were not necessarily the same indices as ours. Race was not available in our databases and deprivation indices were not significant in our analyses of persistent frequent use.…”

Health care utilization and costs of systemic lupus erythematosus in the United States: A systematic review

“…Our review from January 2000 to June 2020 identified 9224 abstracts for review; 479 full-text articles were selected for full-text review (Figure 1). Overall, 51 articles met selection criteria and captured the desired outcomes: health care utilization (28 articles), 10,20–46 drug utilization (20 articles), 11,24,28–30,32–35,37,38,41,42,47–53 adherence (7 articles), 27,49,51,52,54–56 direct costs (20 articles), 10,11,20,22,24,25,28–35,40,42,43,57–59 and indirect costs (14 articles). 11,36,49,58,60–69 Six were prospective studies, 51,56,60,62,68,69 12 were cross-sectional, 36,46,49,52,54,55,61,63–67 and 33 were retrospective 10,11,20–…”

“…More than 60% of the articles had study populations that were more than 90% female. 10,11,20,22,24,26–28,30,32–34,37,38,40,41,49,52,54,56,59–69 More than 60% of studies reported mean/median ages between 36 and 50 years. 10,11,20–22,24,26,32,36–43,45,49,51–57,59,61–64,67,69

Figure 1.Flow diagram of literature screening process.

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“…Twenty-six of 33 retrospective cohort studies used administrative claims databases to examine health care utilization, medication utilization, or direct costs 10,11,20,22,24,26–35,37,38,40–43,48,53,57–59 ; four studies used hospitalization records databases 21,39,44,45 ; one used the US Renal Data System for medication utilization data 47 ; two used the Agency for Health Research and Quality’s Healthcare Cost and Utilization Project (HCUP) database. 23,25 Fifteen studies used commercial claims alone.…”