Younger publicly insured patients at highest risk for readmission to lupus hospital

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Disclosure:
Najjar does not report any relevant financial information. The relevant financial information of all other authors can be found in the study.

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The strongest risk factors for 30-day hospital readmission in patients with systemic lupus erythematosus are younger age, use of statutory health insurance, and SLE-related manifestations, according to data in Arthritis care and research.

“The study was designed in the final months of my residency before I started a fellowship in rheumatology; I really wanted to use my previous experience in clinical epidemiology in research into rheumatological diseases,” Rayan Najjar, MD, MPH, from the University of Washington in Seattle, the study’s lead author, told Healio. “The study uses the Nationwide Readmissions Database to assess independent risk factors for readmission in a sample of patients with SLE.”


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According to data, the strongest risk factors for 30-day hospital readmission in patients with SLE are younger age, use of statutory health insurance, and SLE-related manifestations.

To identify individual risk factors that may predict readmissions to the hospital, Najjar and colleagues analyzed data from the Healthcare Cost and Utilization Project’s Nationwide Readmissions Database (NRD). The database contains information on 36 million layoffs from 28 states in the United States, the researchers wrote.

The study included adult patients who were hospitalized with SLE and discharged between January and November 2016 and 2017. Patients diagnosed with only cutaneous lupus were not included in the study. In addition, the authors did not include patients who lacked length of stay information or expected payer data, or patients who stayed 30 days or more. The researchers used the data to identify the patients’ first readmissions within 30 days of discharge. The 40 most common readmission services and costs for readmission services were recorded.

After accounting for the exclusions, 71,213 patients with SLE were enrolled and included in the analysis. Of these patients, 18,973 were readmitted within 30 days of their initial discharge. Compared with patients who were not hospitalized again within 30 days, patients who were hospitalized were younger and had higher Medicare or Medicaid coverage rates (P

More than 50% of readmissions were by day 11. Other variables associated with increased readmission rates were age from 18 to 30 years compared to those over 65 years (OR = 1.28; 95% CI, 1.17-1.41), glomerular disease (OR = 1.27; 95% CI, 1.19-1.36), congestive heart failure (OR = 1.34; 95% CI, 1.24-1.44), pericarditis (OR = 1.35; 95% CI , 1.14-1.60), pleurisy (OR = 1.24; 95% CI, 1.10-1.40), psychosis (OR = 1.23; 95% CI, 1.11-1.37 ) and autoimmune hemolytic anemia (OR = 1.74; 95% CI, 1.41-2.16).

“We found that the strongest risk factors for 30-day readmission were younger age, SLE-related manifestations, and public insurance,” Najjar said.

“These results identify patient groups with SLE who would benefit from post-discharge interventions aimed at reducing hospitalizations and improving health outcomes,” Najjar added. “In addition to patient morbidity leading to readmissions, we report on the cost and duration of readmissions, which highlights the importance of the early post-hospital period as a potential area for improving health outcomes and reducing the readmissions impact on the healthcare system.”

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