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Identification and Characterization of a High-Need, High-Cost Group Among Hospitalized Patients With Systemic Lupus
Allen Anandarajah1, Caroline Thirukumaran1, Katherine McCarthy1
1University of Rochester, Rochester, New York.
Insights
A small group of high-need, high-cost lupus patients drives most hospitalizations and expenses. These patients exhibit distinct clinical and social factors compared to other lupus patients, highlighting disparities in lupus care.
Area of Science:
- Rheumatology
- Health Services Research
- Clinical Medicine
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with significant healthcare utilization.
- Identifying high-need, high-cost (HNHC) patient groups is crucial for resource allocation and targeted interventions.
- Understanding the unique characteristics of HNHC lupus patients can inform personalized care strategies.
Purpose of the Study:
- To identify a high-need, high-cost (HNHC) cohort among hospitalized lupus patients.
- To compare the clinical and social factors of the HNHC group with those of other hospitalized lupus patients (OHLP).
Main Methods:
- Retrospective analysis of 467 lupus hospitalizations over 3 years at a tertiary care center.
- Comparison of admission rates, 30-day readmissions, length of stay (LOS), and costs between HNHC and OHLP groups.
- Analysis of clinical markers (dsDNA, complement, BMI, SDI, CMI) and social factors (age, race, ethnicity, poverty, medication adherence).
Main Results:
- A distinct HNHC group (44 patients) accounted for a disproportionately high number of hospitalizations and 6-fold higher costs compared to OHLP.
- HNHC patients showed significantly higher dsDNA levels, SDI scores, and CMI scores.
- HNHC patients were more likely to be African American, younger, diagnosed earlier, have lower medication adherence, and live in poverty-stricken areas.
Conclusions:
- A small HNHC patient group significantly impacts overall hospitalizations and costs in lupus care.
- Clinical disparities (higher disease activity and damage) and social determinants of health (race, poverty, adherence) characterize this HNHC lupus cohort.
- Targeted interventions addressing both clinical and social factors are needed for the HNHC lupus population.
Objective:
To identify a high-need, high-cost (HNHC) group among hospitalized lupus patients and to compare clinical and social factors of the HNHC group with those of other patients with lupus.
Methods:
All hospitalizations for lupus in a tertiary care center over a 3-year period were recorded. The number of admissions, 30-day readmissions, length of stay (LOS), and cost of admissions were compared for high-risk patients with those of all other hospitalized lupus patients (OHLP) during this period. We then compared clinical measures (double-stranded DNA [dsDNA] levels, complement proteins, body mass index, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI] scores, and Case Mix Index [CMI] scores) for the HNHC cohort with those of the OHLP group. We additionally differentiated social factors (age, race and ethnicity, poverty, and medication adherence) between the 2 groups.
Results:
A total of 202 patients with lupus accounted for 467 hospitalizations over the study period. The total cost of admissions was $13,192,346. Forty-four patients had significantly higher admissions, 30-day readmissions, and LOS. Furthermore, the cost for this group was 6-fold that for the OHLP group, confirming the presence of an HNHC cohort. The HNHC group had significantly higher dsDNA levels, SDI scores, and CMI scores compared with the OHLP group. Infections were the most common cause of admission for both groups. Patients in the HNHC group were more likely to be African American, younger, diagnosed with lupus at an earlier age, to have lower medication adherence, and to be significantly more likely to live in areas of poverty.
Conclusion:
A small group of patients with lupus (the HNHC group) accounts for most of the hospitalizations and cost. The HNHC group has both social and clinical factors significantly different from other patients with lupus.
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