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

Abstract

Objective Patients with systemic lupus erythematosus (SLE) often struggle with high acute care use (emergency department [ED] visits and hospitalizations) and missed appointments. A nurse‐led integrated care management program (iCMP) at our multihospital system coordinates care for patients at high risk for frequent acute care use due to comorbidities, demographics, and prior use patterns. We studied whether iCMP enrollment was associated with decreased acute care use and missed appointment rates among patients with SLE. Methods We used a validated electronic health record (EHR) machine learning algorithm to identify adults with SLE and then determined which patients were enrolled in the iCMP from January 2012 to February 2019. We then used EHR data linked to insurance claims to compare the incidence rates of ED visits, hospitalizations, potentially avoidable ED visits and hospitalizations, and missed appointments during iCMP enrollment versus the 12 months prior to iCMP enrollment. We used Poisson regression to compare incidence rate ratios (IRRs) during the iCMP versus pre‐iCMP for each use measure, adjusted for age, sex, race and ethnicity, number of comorbidities, and calendar year, accounting for within‐patient clustering. Results We identified 67 iCMP enrollees with SLE and linked EHR claims data. In adjusted analyses, iCMP enrollment was associated with reduced rates of ED visits (IRR 0.63, 95% confidence interval [CI] 0.47‐0.85), avoidable ED visits (IRR 0.50, 95% CI 0.28‐0.88), and avoidable hospitalizations (IRR 0.37, 95% CI 0.21‐0.65). Conclusion A nurse‐led iCMP was effective at decreasing the rate of all ED visits and potentially avoidable ED visits and hospitalizations among high‐risk patients with SLE. Further studies are needed to confirm these findings in other patient populations.

Impact of dementia care training on nurse care managers’ interactions with family caregivers

“…Accountable care organizations (ACOs) are groups of healthcare providers who work together to offer highly coordinated care to high-risk, high-need Medicare beneficiaries [1]. In the United States of America, ACOs have successfully lowered spending and acute care utilization through creation of integrated care management programs in which coordinated care is managed and provided by care managers, often nurses [2,3]. Typical activities of such personnel include facilitating communication between providers, assisting with navigation of the healthcare system, and improving patient access to ensure that care is well coordinated [4].…”

Optimizing Patient Care: A Systematic Review of Multidisciplinary Approaches for SLE Management

“…The different MD teams mostly employed an approach that pivoted on the periodical standard clinical evaluation of the patients (11/19, complemented in 3/19 studies by psychotherapy sessions), regardless of the healthcare professionals involved. In 4/19 cases, intervention focused on gathering information through in-person meetings or phone calls, without the direct involvement of a rheumatologist [ 12 , 15 , 21 , 23 ]. Except for the management of pregnancy-related and psychological issues in SLE, we found heterogeneous examples of MD approaches to SLE patients.…”

“…Patients were then referred to a nurse leading the integrated care management program who evaluated each patient’s health status and coordinated his/her care needs. The rheumatologist did not evaluate the patients systematically unless the leading nurse deemed it necessary; otherwise, the patient was addressed to the most appropriate figure, including social workers, community resource specialists, or pharmacists [ 23 ].…”

“…Review of authors’ judgements about each risk of bias using NIH risk of bias tool. Green box = “yes/low risk of bias”; yellow box = “not applicable/not reported”; red box = “no/potential risk of bias” [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”

A multi-step approach to develop a “storytelling” intervention to improve patient gout knowledge and improve outpatient follow-up

“…In the future, we could test such an intervention in numerous venues using various study designs (e.g., clinical trials) or quality improvement activities aimed at improving gout outcomes. Moreover, our methods may be more generalizable than the stories’ content, since the methods we used to develop the storytelling intervention may be employed in a similar manner to create interventions for other chronic conditions focusing on outpatient follow-up [ [53] , [54] , [55] ] and medication adherence [ [56] , [57] , [58] ] to improve outcomes. Transporting the intervention to a new cultural context might require the development of new stories by storytellers who are culturally congruent using the same methodology.…”