Thirty‐Day Hospital Readmissions in Systemic Lupus Erythematosus: Predictors and Hospital‐ and State‐Level Variation

Abstract

Objective Systemic lupus erythematosus (SLE) has among the highest hospital readmission rates among chronic conditions. We sought to identify patient-level, hospital-level, and geographic predictors of 30-day hospital readmissions in SLE. Methods Using hospital discharge databases from 5 geographically dispersed states, we performed a study of all-cause SLE readmissions between 2008 and 2009. We evaluated each hospitalization as a possible index event leading up to a readmission, our primary outcome. We accounted for clustering of hospitalizations within patients and within hospitals and adjusted for hospital case-mix. Using multi-level mixed-effects logistic regression, we examined factors associated with 30-day readmissions and calculated risk-standardized hospital-level and state-level readmission rates. Results We examined 55,936 hospitalizations among 31,903 patients with SLE. 9,244 (16.5%) hospitalizations resulted in readmission within 30 days. In adjusted analyses, age was inversely related to risk of readmission. Black and Hispanic patients were more likely to be readmitted compared to white patients, as were those with Medicare or Medicaid insurance (versus private insurance). Several lupus clinical characteristics, including lupus nephritis, serositis and thrombocytopenia were associated with readmission. Readmission rates varied significantly between hospitals after accounting for patient-level clustering and hospital case mix. There was also geographic variation, with risk-adjusted readmission rates lower in New York and higher in Florida compared to California. Conclusions We found that about 1 in 6 hospitalized patients with SLE were readmitted within 30 days, with higher rates in historically underserved populations. Significant geographic and hospital-level variation in risk-adjusted readmission rates suggests potential for quality improvement.

Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study

“…The long-term survival of SLE has markedly improved over the past decades [2], but the risk of premature death has plateaued since 1999 [3] and considerable morbidity continues to afflict affected patients [4]. Patients with SLE are commonly hospitalized [5] and SLE has become over the past two decades the most common autoimmune disease in the ICU [6]. The substantial immune dysfunction among patients with SLE increases their risk of serious infectious complications [7].…”

Medication Nonadherence Is Associated With Increased Subsequent Acute Care Utilization Among Medicaid Beneficiaries With Systemic Lupus Erythematosus

“…A number of studies demonstrate the high costs of SLE patient care that are in large part due to high health care utilization . Each year, 1 in 4 SLE patients are hospitalized, 1 in 6 hospitalized patients are readmitted within 30 days of discharge, and 1 in 2 SLE patients visit the emergency department (ED) . Among cardiovascular disease patients, adherence has been shown to significantly impact health care utilization, costs, and mortality .…”

The Epidemiology and Outcomes of Mental Disorders in Critically Ill Patients With Systemic Lupus Erythematosus: A Population-Based Study

“…Although the long-term survival of SLE has progressively improved over the past decades [ 2 ], the risk of premature death has plateaued since 1999 [ 3 ] and patients continue to be affected by considerable morbidity [ 4 ]. Patients with SLE are commonly hospitalized [ 5 ] and SLE has become over the past 2 decades the most common autoimmune disease in the intensive care unit (ICU) [ 6 ] with reported high risk of death [ 7 , 8 ].…”