Background/Purpose: We previously demonstrated that a small group of high risk, high cost patients (HRHC) account for majority of the hospitalizations, length of stay (LOS) and overall cost among all lupus patients admitted to an academic medical center. Herein, we assessed the impact of an intervention to improve access to rheumatology care for HRHC lupus patients by comparing the number of hospital admissions and LOS in the HRHC cohort compared to hospitalized lupus patients not meeting HRHC criteria.

Methods: Lupus patients who required 3 or more admissions over a 3-year period between 2013 and 2016 were categorized as HRHC patients. Most of these patients were from the poor, urban communities and were mostly African American. A project to improve quality for low-income, underprivileged, poor, underage, SLE (IQ-LUPUS) patients was started in July 2018. One of the goals of the IQ-LUPUS project is to enhance access for the HRHC patients to rheumatology care by offering direct access to a nurse care coordinator and a social worker who provide medical advice, remind and facilitate outpatient visits, enable educational activities and organize home visits. Additionally, we opened a clinic in the urban community. We compared the no show rates for the HRHC patients with all lupus patients and all rheumatology patients seen in the outpatient clinics at URMC for the fiscal year (FY) 2017 (prior to project) with FY 2018 (since starting project). We also determined the hospitalization rates and LOS for all admissions among the HRHC patients enrolled in the project, for first 10 months of FY 2017 with the first 10 months of FY 18. The gender, age and the diagnoses on admission were all documented.

Results: A total of 54 HRHC patients are enrolled in the IQ-LUPUS project to date. No show rates for these HRHC patients was 12.1% for FY 2017, 5.8% for all lupus patients and 4.3% for all patients seen at the Rheumatology clinic. The no show rates for the HRHC patients decreased 1.3% for FY 2018 (p=0.62) but increased in all lupus patients (0.8%) and all rheumatology patients (0.7%). In 2017, 16 of the HRHC patients had 52 admissions in 2017 for a total LOS of 231 days. All patients were female with a mean age of 32.9 years. In 2018, the number of admissions decreased to 36 (p=0.3). These admissions included 17 patients and a total LOS of 159 days (p=0.5)). All patients were female with a mean age of 32.5 years. The number of 30-day readmissions also decreased from 21 in 2017 to 14 in 2018. Although no statistical significance was noted early results of the IQ-LUPUS project suggests that improving access can decrease hospitalizations.

Conclusion:

Methods aimed at improving access to rheumatology care through care coordination and special clinics can decrease the number of hospitalizations and LOS among high risk SLE patients. Further studies are needed to further define and implement targeted interventions that decrease hospital admissions and improve quality of care for this vulnerable population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-access-to-rheumatology-care-for-high-risk-lupus-patients-can-help-decrease-hospitalizations/