Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13‐Year Population Health Study

Abstract

Objective. To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of systemic lupus erythematosus (SLE) cases and matched control patients over 13 years. Methods. A retrospective cohort study was performed utilizing administrative health care data from approximately 1 million people with access to universal health care. Using International Classification of Diseases, Ninth and Tenth Revisions diagnostic codes, 7 SLE case definitions were used. Each case was matched by age and sex to 4 randomly selected controls. Data included physician billings, ER visits, and hospital discharges over 13 years.Results. The number of incident SLE cases varied from 564 to 4,494 depending on the case definition used. The mean age varied from 47.7 to 50.6 years and the proportion of females from 78.0% to 85.1%. SLE utilization of physicians was highest in the index year, and declined significantly thereafter for all case definitions. By the fourth year, encounters with subspecialty physicians fell by 60% (rheumatologists), 50% (internists), and 31% (other physicians). In contrast, visits to family physicians fell by only 9%. Visits to the ER and hospital admissions for SLE cases were also more frequent early in the disease course and fell significantly over the study for both ER visits (all case definitions) and hospitalizations (2 of 7 case definitions). Conclusion. In SLE patients, health care utilization is highest in the first few years following the diagnosis, which is also the time of maximal involvement by rheumatologists. Utilization declines over time, and encounters with patients' family physicians predominate over those of other physician groups.

A Longitudinal Study of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Patients with Rheumatoid Arthritis: A 13-year Population Health Study

“…It is to be expected that multiple physician groups will be involved in the care of patients with RA given the systemic nature of the illness and the higher frequency of co-morbidities. Indeed, we recently reported a very similar pattern of health care utilization in patients with SLE (16). In the current study, physician encounters were categorized into those with family physicians, general internists, rheumatologists and others.…”

Causes and factors related to hospitalizations in patients with systemic lupus erythematosus: analysis of a 20-year period (1995–2015) from a single referral centre in Catalonia

“…The fact that lower duration of disease and lower SLICC were associated with admission due to flare strengthens the findings from previous data that flares occur earlier during the disease with other causes of admission occurring later owing to accumulated damage/therapy iatrogenesis. 1,4,7,18 The presence of hypertension also as a protective factor for flare admission might also be related to this fact, with this comorbidity occurring more prevalently in older patients.…”

Feasibility, Validity, and Reliability of the 10-item Patient Reported Outcomes Measurement Information System Global Health Short Form in Outpatients with Systemic Lupus Erythematosus

“…PROMIS10 can be used to track patient outcomes across a health system, which is particularly important in rheumatology patients who may see numerous providers for management of their multisystem conditions. Patients with SLE, for example, often see nephrologists, cardiologists, neurologists, ophthalmologists, orthopedists, and internists in addition to their rheumatologists, with certain populations more likely to have their SLE managed by nonrheumatologists 29,30,31,32 . The use of a universal quality-of-life measure, rather than multiple condition-specific instruments, may be more convenient and meaningful to providers, who lack familiarity with disease measures outside their specialty, and to patients who have multiple comorbid conditions, the effects of which may be difficult to tease apart.…”