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Fragmented care linked to infection, comorbidities among patients with SLE
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Care fragmentation in the treatment of patients with systemic lupus erythematosus was associated with elevated risk for severe infection and comorbidities, according to findings.
Researchers evaluated patients enrolled in the Chicago HealthLNK Data Repository (HDR) and identified 4,276 patients who met the criteria for systemic lupus erythematosus (SLE). They used ICD-9 diagnostic codes to identify any serious infections the patients may have experienced during the study interval. Additionally, ICD-9 codes were used to determine whether patients had been diagnosed with any of the following SLE-related comorbid conditions: cardiovascular disease (CVD); stroke; nephritis; and end-stage renal disease (ESRD). They identified cases of fragmented care, which was defined as one or more visits with an ICD-9 code of 710.0 at two or more institutions between Jan. 1, 2006 and Dec. 1, 2012.
20% of the patients were seen for care at more than one health care institution. The probability of care fragmentation was greater for African American patients vs. white patients (odds ratio [OR]: 1.66) and in recipients of public vs. private insurance (OR: 1.63). In patients with fragmented care, a statistically greater median number of months was spent in the HDR (66 vs. 61). These patients also had a greater median number of visits for care related to SLE.
who received care in just one health system. Severe infections were also more likely in this population when inpatient infections were evaluated separately (OR: 1.61).
In an analysis adjusted for age, sex, race, insurance status, length of follow-up and total visit count, patients with fragmented care had an increased risk of the following: infections (OR: 1.57); CVD (OR: 1.51); end-stage renal disease (OR: 1.34); nephritis (OR: 1.28) and stroke (OR: 1.28).
damage accrual for SLE patients, our study suggests that improving care coordination and access to a more complete set of medical record data may be a key strategy for improving health outcomes for SLE patients,” the researchers wrote. “While true health information exchange is available in limited regions of the [United States] U.S., other solutions that integrate EHR data may increase data sharing.” -by Jennifer Byrne
Disclosures: The researchers report no relevant disclosures.
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