Background/Purpose: SLE is a chronic multi-system autoimmune disease, affecting mostly women of child-bearing age and more racial minorities, with a wide spectrum of outcomes: from long-standing remission to frequent flares and mortality. Although survival rate of SLE has improved, healthcare utilization among SLE patients is still high, including hospitalizations. Our internal data indicate that 30-day readmission rate among SLE patients is 28%. CarePlus is a team-based primary care for healthcare super-utilizers at Wake Forest Baptist Medical Center (WFBMC). The objective of the initial pilot study was to test if team-based care through CarePlus with comprehensive services (i.e. mental health care, medication education, social assistance and patient hotline) would help reduce healthcare utilization of those SLE patients with the highest utilization ( >3 admissions/ED visits in 18 months). Their primary rheumatologists contacted each patient to determine interest in enrollment in the CarePlus program. Only those interested at that time were included in the pilot study. The initial study was prematurely discontinued due to difficulty of contacting patients, scheduling, and no showing to appointments. The aim of this study was to characterize patient factors in declining CarePlus and barriers to attending the initial CarePlus appointment.

Methods: In the initial pilot study, a cohort of patients with SLE were identified as healthcare super-utilizers and 12 agreed to be scheduled with CarePlus. For those 12 patients, demographics were obtained via chart review. Study-eligible SLE patients were interviewed over the phone about reasons for declining CarePlus and barriers to attending the initial appointment.

Results: Median age was 44 years (range 27-64) with 92% female. Thirty-three percent were Caucasian, 50% African-American, and 17% Hispanic. Two-thirds had previously no-showed to rheumatology appointments. Three patients were successfully enrolled in CarePlus (only 1 during the 5 month study enrollment period). All 3 enrolled patients live in the county in which the clinic is located or adjacent county; the 8 patients who did not enroll lived further out of these counties.  Of the 9 patients who did not enroll, eight patients could be contacted and interviewed. Factors in declining CarePlus and barriers to attending appointments included: personal health issues (3), did not want to switch primary care physician (2), transportation (2), and forgetfulness (2). Subsequent to the interview, two patients still wanted to enroll in CarePlus.

Conclusion: The qualitative review of the factors that led patients to fail to establish in the CarePlus program provides new insights into how to better structure a patient-centered home for our SLE healthcare super-utilizers.  Specific factors such as the established relationship with their current primary care doctors and proximity to the clinic were limitations to our study’s enrollment.  The recent increased implementation of telemedicine may be a unique and helpful tool in developing a more effective team-based approach for the care of SLE super-utilizers in the future especially to address the barriers noted in this particular study.

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/qualitative-review-of-unsuccessful-pilot-study-of-super-utilizer-systemic-lupus-erythematosus-sle-patients-enrollment-into-team-based-program-to-improve-patient-outcomes/