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Systemic Lupus Erythematosus
Thirty-Day Hospital Readmissions in Systemic Lupus Erythematosus: Predictors and Hospital- and State-Level Variation†
Article first published online: 26 SEP 2014
Copyright © 2014 by the American College of Rheumatology
Arthritis & Rheumatology
Volume 66, Issue 10, pages 2828–2836, October 2014
How to Cite
Yazdany, J., Marafino, B. J., Dean, M. L., Bardach, N. S., Duseja, R., Ward, M. M. and Dudley, R. A. (2014), Thirty-Day Hospital Readmissions in Systemic Lupus Erythematosus: Predictors and Hospital- and State-Level Variation. Arthritis & Rheumatology, 66: 2828–2836. doi: 10.1002/art.38768
- Issue published online: 26 SEP 2014
- Article first published online: 26 SEP 2014
- Accepted manuscript online: 11 AUG 2014 01:00AM EST
- Manuscript Accepted: 26 JUN 2014
- Manuscript Received: 20 APR 2014
- NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases). Grant Numbers: K23-AR-060259, P60-AR-053308
- University of California
- San Francisco Comparative Effectiveness Large Dataset Analysis Core
- Rosalind Russell Medical Research Center for Arthritis
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH
Systemic lupus erythematosus (SLE) has one of the highest hospital readmission rates among chronic conditions. This study was undertaken to identify patient-level, hospital-level, and geographic predictors of 30-day hospital readmissions associated with SLE.
Using hospital discharge databases from 5 geographically dispersed states, we studied all-cause readmission of SLE patients between 2008 and 2009. We evaluated each hospitalization as a possible index event leading up to a readmission, our primary outcome. We accounted for clustering of hospitalizations within patients and within hospitals and adjusted for hospital case mix. Using multilevel mixed-effects logistic regression, we examined factors associated with 30-day readmission and calculated risk-standardized hospital-level and state-level readmission rates.
We examined 55,936 hospitalizations among 31,903 patients with SLE. Of these hospitalizations, 9,244 (16.5%) resulted in readmission within 30 days. In adjusted analyses, age was inversely related to risk of readmission. African American and Hispanic patients were more likely to be readmitted than white patients, as were those with Medicare or Medicaid insurance (versus private insurance). Several clinical characteristics of lupus, including nephritis, serositis, and thrombocytopenia, were associated with readmission. Readmission rates varied significantly between hospitals after accounting for patient-level clustering and hospital case mix. We also found geographic variation, with risk-adjusted readmission rates lower in New York and higher in Florida as compared to California.
We found that ∼1 in 6 hospitalized patients with SLE were readmitted within 30 days of discharge, with higher rates among historically underserved populations. Significant geographic and hospital-level variation in risk-adjusted readmission rates suggests potential for quality improvement.