Candace H Feldman1, Chang Xu2, Jessica Williams2, Jamie E Collins3, Karen H Costenbader2. 1. Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, United States. Electronic address: cfeldman@bwh.harvard.edu. 2. Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, United States. 3. OrACORe, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States.
Abstract
OBJECTIVES: We aimed to identify longitudinal patterns and predictors of acute care use (emergency department [ED] visits and hospitalizations) among individuals with SLE enrolled in Medicaid, the largest U.S. public insurance. METHODS: Using Medicaid data (29 states, 2000-2010) we identified 18-65-year-olds with SLE (≥3 SLE ICD-9 codes, 3rd code=index date), ≥12 months of enrollment prior to the index date and ≥24 months post. For each 90-day interval post index date, patients were assigned binary indicators (1=≥1 ED visit or hospitalization, 0=none). We used group-based trajectory models to graph patterns of overall and SLE-specific acute care use, and multinomial logistic regression models to examine predictors. RESULTS: Among 40,381 SLE patients, the mean age was 40.8 (SD 11.9). Using a three-group trajectory model, 2,342 (6%) were recurrent all-cause high acute care utilizers, 12,932 (32%) moderate, 25,107 (62%) infrequent; 25% were moderate or high utilizers for SLE. There were higher odds of all-cause, recurrent acute care use (vs. infrequent) among patients with severe vs. mild SLE (OR 3.37, 95% CI 3.0-3.78), chronic pain (odds ratio [OR] 1.63, 95% CI 1.15-2.32), depression (OR 1.90 95% CI 1.74-2.09), and cardiovascular disease (OR 2.29, 95% CI 2.08-2.52). Older age, male sex and hydroxychloroquine use were associated with lower odds of recurrent overall and SLE-specific acute care use. CONCLUSION: Nearly 40% of Medicaid beneficiaries with SLE are recurrent all-cause acute care utilizers; 25% have recurrent use for SLE. Modifiable factors, including outpatient management of SLE and comorbidities, may reduce avoidable acute care use.
OBJECTIVES: We aimed to identify longitudinal patterns and predictors of acute care use (emergency department [ED] visits and hospitalizations) among individuals with SLE enrolled in Medicaid, the largest U.S. public insurance. METHODS: Using Medicaid data (29 states, 2000-2010) we identified 18-65-year-olds with SLE (≥3 SLE ICD-9 codes, 3rd code=index date), ≥12 months of enrollment prior to the index date and ≥24 months post. For each 90-day interval post index date, patients were assigned binary indicators (1=≥1 ED visit or hospitalization, 0=none). We used group-based trajectory models to graph patterns of overall and SLE-specific acute care use, and multinomial logistic regression models to examine predictors. RESULTS: Among 40,381 SLE patients, the mean age was 40.8 (SD 11.9). Using a three-group trajectory model, 2,342 (6%) were recurrent all-cause high acute care utilizers, 12,932 (32%) moderate, 25,107 (62%) infrequent; 25% were moderate or high utilizers for SLE. There were higher odds of all-cause, recurrent acute care use (vs. infrequent) among patients with severe vs. mild SLE (OR 3.37, 95% CI 3.0-3.78), chronic pain (odds ratio [OR] 1.63, 95% CI 1.15-2.32), depression (OR 1.90 95% CI 1.74-2.09), and cardiovascular disease (OR 2.29, 95% CI 2.08-2.52). Older age, male sex and hydroxychloroquine use were associated with lower odds of recurrent overall and SLE-specific acute care use. CONCLUSION: Nearly 40% of Medicaid beneficiaries with SLE are recurrent all-cause acute care utilizers; 25% have recurrent use for SLE. Modifiable factors, including outpatient management of SLE and comorbidities, may reduce avoidable acute care use.
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