The study: Wanty NI, Cooper DL, Simkus A, et al. A provider-based approach to address racial disparities in lupus clinical trial participation. Arthritis Care Res (Hoboken). 2022 Nov 7. doi: 10.1002/acr.25054. Epub ahead of print.
Post-Discharge Follow-Up in Lupus
By Maria Schletzbaum, PhD, & Christie Bartels, MD, MS
Why was this study done? Many patients with systemic lupus erythematosus are hospitalized—some frequently. In other chronic diseases, follow-up visits shortly after discharge reduce the risk of readmission within 30 days. We wanted to know how many patients with lupus had visits with their primary care provider or rheumatologist after leaving the hospital, and if such visits decreased the risk of a return to the hospital, to the emergency department (ED) or death.
What were the study methods? The study included 8,606 patients with lupus who were hospitalized and had Medicare coverage. We report how many patients completed a visit with a primary care provider or rheumatologist, and how many experienced a hospitalization, ED visit or death in the 30 days after discharge. We used multivariable logistic regression to evaluate which patients were less likely to have follow-up visits. Using Cox proportional hazards models with a time variable for follow-up, we conducted a survival analysis to assess whether follow-up visits affected the risk of readmission, ED visit or death.
What were the key findings? Over one-third of patients with lupus (35%) lacked follow-up within 30 days; 18% had their first follow-up visit with a rheumatologist. Lack of visits was more common in rural areas and highly socioeconomically disadvantaged neighborhoods. For patients aged 65 or older, follow-up was associated with 27% higher subsequent hospital or ED use, but 65% lower mortality. Visits with rheumatologists were not associated with acute care or mortality.
What are the main conclusions? Post-discharge follow-up visits are important and are likely underutilized in the care of patients with lupus. Greater rheumatologist involvement in post-discharge care and outreach to patients in rural and socioeconomically disadvantaged areas could be beneficial.
What are the implications for patients? It is important for patients with lupus to attend visits with their primary care provider or rheumatologist within 30 days of leaving the hospital.
What are the implications for clinicians? Post-hospital care of patients with lupus is important. Timely post-discharge visits aim to limit readmissions, ED visits and may significantly reduce mortality among older patients.
The study: Schletzbaum M, Sweet N, Astor B, et al. Associations of post-discharge follow-up with acute care and mortality in lupus: A Medicare cohort study. Arthritis Care Res. 2023 Feb 8. doi: 10.1002/acr.25097. Epub ahead of print.
