Lupus Patients Face High Rehospitalization Rates

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Indeed, more severe disease was associated with a higher likelihood of readmission. Three conditions in particular dominated the readmissions: low blood platelet count; kidney inflammation (called lupus nephritis); and an inflammation of the linings of the organs (serositis).

"Thirty-day hospitalization readmission rates are sometimes used as a measure of quality, but with sick people, it can really be a measure of the severity of their illness," said Dr. David Pisetsky, a professor of medicine at Duke University School of Medicine and a member of the scientific advisory board at the Lupus Research Institute.

However, other important differences emerged. Black and Hispanic patients were more likely to be readmitted than white patients. "That suggests there may be a racial disparity in the things that influence readmission, such as the quality of care delivered or the transition to the outpatient setting, or poor access to outpatient care. But we need further research to find out whether that's the case," Yazdany said.

Patients covered by Medicaid and Medicare, the U.S. publicly funded insurance programs, were also about 1.5 times more likely to be readmitted than privately insured patients.

"You have to get the disease under control, and for people who are on Medicare or Medicaid and don't have access to medications, that can be more difficult," Pisetsky said.

Further, New York had the lowest readmission rates of the five states studied. That suggests room for quality improvement, Yazdany said, though she added that New York has a higher concentration of dedicated lupus centers than many other places.

"Evidence suggests the rate of readmissions can be reduced by improving discharge planning and the transition process out of the hospital," Yazdany said.

An effective transition requires coordination of care between health care providers at the hospital and a patient's outpatient doctors, she said. It also requires that patients know when their follow-up outpatient appointments are, what symptoms to worry about and whom to call if needed.

"We have a lot of work to do in educating and supporting patients in managing their disease," Yazdany said. And lupus patients "should be very proactive," she added.

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SOURCES: Jinoos Yazdany, M.D., M.P.H., associate professor, medicine, University of California, San Francisco; Joan Merrill, M.D., medical director, Lupus Foundation of America, and head, clinical pharmacology research program, Oklahoma Medical Research Foundation, Oklahoma City; David Pisetsky, M.D., Ph.D., professor, medicine, Duke University School of Medicine, Durham, N.C., and scientific advisory board member, Lupus Research Institute, New York City; Aug. 11, 2014, Arthritis & Rheumatology
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