Background/Purpose:   SLE patients frequent the emergency department (ED) irrespective of their access to care, which raises concerns regarding the quality of care in the ambulatory setting. We investigated the characteristics and patterns of ED utilization among MILES Cohort participants to identify opportunities to improve quality of care in SLE.

Methods:   Data were derived from the baseline visit of MILES, a longitudinal, population-based cohort of SLE patients and controls in southeastern Michigan. Frequency of ED utilization in the preceding 12 months was categorized as none, 1-2 visits, or 3 or more visits. We used stratified multivariable ordered logistic regression to evaluate factors associated with increasing frequency of ED utilization. Variables determined a priori to be important, or with p-values <0.1 in univariate analysis, were included in multivariable models (listed in Table 2).

Results: Characteristics of the MILES Cohort participants (462 SLE patients and 192 controls) at baseline visit is summarized in Table 1. ED utilization grouped by frequency is shown in Figure 1, where SLE patients reported a total of 572 ED encounters and controls a total of 113 ED encounters. SLE patients reported higher pain scores and pain catastrophizing scores compared to controls, and more reported current opioid use (p<0.001). In stratified multivariable ordered logistic analysis, increasing frequency of ED utilization among SLE patients was associated with black race [OR 1.53 (95% CI 1.01-2.31)], Medicaid coverage [2.35 (1.28-4.33)], and current opioid use [2.19 (1.41-3.42)]. Among controls, black race [2.33 (1.08-5.03)] and higher pain catastrophizing scores [1.06 (1.00-1.12)] were associated with increasing frequency of ED utilization.

Conclusion:   Factors associated with increasing frequency of ED utilization among SLE patients differ from those among controls from the general population. Although SLE patients experience high pain burden, only current opioid use is associated with frequent ED utilization. Opioid therapy is associated with high morbidity and mortality, and further study aimed at understanding opioid prescribing practices for SLE patients who frequent the ED is warranted to identify opportunities to improve quality of care.