MONDAY, Aug. 11, 2014 (HealthDay News) -- One in six
hospitalized lupus patients requires readmission to the hospital
within a month after discharge, according to a new study.
While patients' disease severity contributed to readmission
rates, other population differences suggest hospitals might be able
to reduce rehospitalizations through better discharge plans and by
addressing disparities in health care, said Dr. Jinoos Yazdany,
lead researcher and associate professor of medicine at the
University of California, San Francisco.
Lupus is a disease in which the immune system attacks the body.
Although researchers don't understand all of its causes, there is a
genetic component to the disease, Yazdany said. Drugs that suppress
the immune system can help control lupus but often with bad side
Lupus afflicts approximately 10 times more women than men and
disproportionately affects racial and ethnic minorities and lower
socioeconomic groups, she said.
"There are likely environmental, psychosocial, biological and even health care factors that play a role," Yazdany said. "No one strategy is going to be enough to eliminate these differences we see in lupus prevalence."
For the study, published online Aug. 11 in
Arthritis & Rheumatology, Yazdany's team analyzed
hospital discharge records in 2008 and 2009 for about 32,000
patients from more than 800 hospitals in New York, Florida, Utah,
California and Washington.
Causes of initial hospitalization generally fell into three
categories, Yazdany said. The first arose from the disease itself,
such as inflammation or organ failure. The second resulted from
other conditions, such as heart disease or diabetes, which commonly
coexist with lupus.
The last category included infections. The same drugs that
suppress the immune system so that lupus can't attack the body also
reduce a person's ability to fight off bacterial and viral
These reasons also provide clues regarding the study's finding
that 16.5 percent of patients were readmitted to the hospital
within 30 days.
"If you have more severe manifestations of the lupus that brought you to the hospital, you're going to be treated with aggressive immunosuppressants, and that's going to increase your risk of infection," said Dr. Joan Merrill, medical director of the Lupus Foundation of America and head of clinical pharmacology research at Oklahoma Medical Research Foundation. "That's going to increase your risk of rehospitalization, and/or if the treatments don't work, then you're at risk of organ failure."
Indeed, more severe disease was associated with a higher
likelihood of readmission. Three conditions in particular dominated
the readmissions: low blood platelet count; kidney inflammation
(called lupus nephritis); and an inflammation of the linings of the
"Thirty-day hospitalization readmission rates are sometimes used as a measure of quality, but with sick people, it can really be a measure of the severity of their illness," said Dr. David Pisetsky, a professor of medicine at Duke University School of Medicine and a member of the scientific advisory board at the Lupus Research Institute.
However, other important differences emerged. Black and Hispanic
patients were more likely to be readmitted than white patients.
"That suggests there may be a racial disparity in the things that
influence readmission, such as the quality of care delivered or the
transition to the outpatient setting, or poor access to outpatient
care. But we need further research to find out whether that's the
case," Yazdany said.
Patients covered by Medicaid and Medicare, the U.S. publicly
funded insurance programs, were also about 1.5 times more likely to
be readmitted than privately insured patients.
"You have to get the disease under control, and for people who are on Medicare or Medicaid and don't have access to medications, that can be more difficult," Pisetsky said.
Further, New York had the lowest readmission rates of the five
states studied. That suggests room for quality improvement, Yazdany
said, though she added that New York has a higher concentration of
dedicated lupus centers than many other places.
"Evidence suggests the rate of readmissions can be reduced by improving discharge planning and the transition process out of the hospital," Yazdany said.
An effective transition requires coordination of care between
health care providers at the hospital and a patient's outpatient
doctors, she said. It also requires that patients know when their
follow-up outpatient appointments are, what symptoms to worry about
and whom to call if needed.
"We have a lot of work to do in educating and supporting patients in managing their disease," Yazdany said. And lupus patients "should be very proactive," she added.
Learn more about lupus at the
Lupus Foundation of America.
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