Lupus patient readmission rates are high and vary considerably by hospital, region, study finds

Approximately 1 in 6 hospitalized patients with systemic lupus erythematosus (SLE) were readmitted to the hospital within 30 days, according to a new study.

Researchers used hospital discharge databases from 5 states to study all-cause readmissions in patients with SLE that occurred between 2008 and 2009. Each hospitalization was evaluated as a possible index event leading to a readmission. The researchers adjusted for hospital case-mix and accounted for within-patient and within-hospital clustering of hospitalizations. Factors associated with 30-day readmission rates were also examined. The study results were published online Aug. 11 by Arthritis & Rheumatology.

A total of 55,936 hospitalizations in 31,903 patients with SLE were analyzed. Of these hospitalizations, 9,244 (16.5%) led to a readmission within 30 days in 4,916 patients. Age was inversely related to readmission risk in adjusted analyses. Black and Hispanic patients were more likely to be readmitted than white patients, and patients insured by Medicare and Medicaid were more likely to be readmitted than those with private insurance. Rural patients were less likely to be readmitted. An association with readmission was also seen in patients with lupus nephritis, serositis, and thrombocytopenia. After adjustment for case-mix and patient-level clustering, a significant variation in readmission rates was seen between hospitals. Geographic variation was also noted.

The authors noted that their study included data from only 5 states and therefore their results may not apply to all U.S. patients with SLE. They also acknowledged that they used administrative data and that some of the states in the study did not specify planned or acute readmission. However, they concluded that 30-day readmission rates appear to be notable in patients with SLE and that sociodemographic characteristics such as ethnicity and insurance type were important readmission predictors. They also said the association between younger age and readmission could be due to greater severity of SLE in younger patients.

“Taken together, our findings regarding both risk factors and variability in 30-day readmissions suggest that readmissions may be an important outcome measure in SLE,” the authors wrote. Their findings provide data on both demographic and clinical risk factors that may be helpful to physicians in ambulatory care and hospital settings, they noted. “Although our study does not address the reasons for variation in readmission rates between hospitals and states, the presence of unexplained variation after careful risk adjustment suggests that there is room for quality improvement,” they wrote. “Further work to identify care processes that can reduce readmission rates for this complex disease is needed.”