BETHESDA, Maryland—The onus may be on rheumatologists to help prevent avoidable hospitalizations for such illnesses as pneumonia and congestive heart failure that are seen among older, poorer patients with systemic lupus erythematosus (SLE), according to Michael M. Ward, in Arthritis Care and Research.¹

"To the extent that rheumatologists serve as primary care providers for their patients with SLE, [avoidable hospitalizations] may reflect suboptimal access to care from rheumatologists," Dr. Ward, with the National Institutes of Health in Bethesda, Maryland, writes. "Identifying the processes leading to avoidable hospitalization in these patients may suggest strategies to reduce preventable illness."

Risk for avoidable hospitalization higher in older, poorer lupus patients

Dr. Ward reviewed data from 2000 through 2002 on the acute-care hospitalizations seen among 8670 SLE patients aged ≥18 or older in New York. The hospitalizations were classified as "avoidable" based on the principal indication for admission. Avoidable hospitalizations comprise those for which "the circumstances leading to the hospitalizations, if altered, may have eliminated the need for hospitalization."

Of 16,751 admissions, 2123 (12.7%) were for avoidable conditions including pneumonia, congestive heart failure, and cellulitis. The risk for avoidable hospitalizations increased progressively with advancing age, possibly because these patients had more comorbidities, greater difficulty managing multiple medication regimens, and less social support.

The risk of being hospitalized for an avoidable condition was also higher among patients with Medicare than among those with other types of insurance. Moreover, the risk of avoidable hospitalizations was higher among those SLE patients of lower socioeconomic status.

"These findings may indicate poorer access to primary care for these patients, poorer monitoring of ongoing conditions, or delays in seeking care," Dr. Ward concludes.

Admissions for avoidable conditions were 18% to 23% less likely to occur at hospitals that admitted larger numbers of SLE patients, compared with hospitals that see fewer SLE patients.

There are several reasons that could explain these findings, Dr. Ward writes. First, "primary and secondary care hospitals might be expected to treat a larger proportion of patients with common acute problems." Second, patients who choose to be treated at a high-volume hospital may be more proactive about their health, which could affect their risk of becoming hospitalized for an avoidable condition, he writes. Or "high volume hospitals (or academic centers of teaching hospitals) may have physicians who provide higher-quality outpatient care."

Reference

1. Ward MM. Avoidable hospitalizations in patients with systemic lupus erythematosus. Arthritis Care Res. 2008;59:162-168.