Quality Improvement Intervention to Reduce Thirty‐Day Hospital Readmission Rates Among Patients With Systemic Lupus Erythematosus

Abstract

Objective Systemic lupus erythematosus (SLE) has one of the highest 30‐day hospital readmission rates among chronic diseases in the US. This quality improvement initiative developed and assessed the feasibility of a multidisciplinary postdischarge intervention to reduce 30‐day readmission rates among SLE patients. Methods A retrospective study was performed using electronic health records of patients with SLE admitted to a university hospital prior to (nonintervention group) and after initiation of the study intervention (intervention group). The study population included patients with a diagnosis of SLE who were admitted to the hospital for any reason during an 8‐month time period. The intervention involved sending a templated message at the time of discharge to the rheumatology clinic nurses, which prompted the nurses to call the patient to coordinate future visits and provide education. The primary outcome was the 30‐day hospital readmission rate. Data were analyzed using a multivariate mixed binomial regression model. Results There were 59 hospitalizations in the nonintervention group and 73 hospitalizations in the intervention group during the 8‐month study period. The 30‐day readmission rate was 29% in the nonintervention group and 19% in the intervention group. The difference in readmission rates between the 2 groups was not statistically significant based on the multivariate model. Conclusion Our study demonstrates the feasibility of implementing a multidisciplinary postdischarge intervention to reduce readmission rates for patients with SLE in a large academic medical center. Further investigation is warranted to determine if this approach reduces the unacceptably high hospital readmission rates among SLE patients.

Optimizing Patient Care: A Systematic Review of Multidisciplinary Approaches for SLE Management

“…The different MD teams mostly employed an approach that pivoted on the periodical standard clinical evaluation of the patients (11/19, complemented in 3/19 studies by psychotherapy sessions), regardless of the healthcare professionals involved. In 4/19 cases, intervention focused on gathering information through in-person meetings or phone calls, without the direct involvement of a rheumatologist [ 12 , 15 , 21 , 23 ]. Except for the management of pregnancy-related and psychological issues in SLE, we found heterogeneous examples of MD approaches to SLE patients.…”

“…Review of authors’ judgements about each risk of bias using NIH risk of bias tool. Green box = “yes/low risk of bias”; yellow box = “not applicable/not reported”; red box = “no/potential risk of bias” [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”

“…If a comparator group was absent or the effect of MD was not significantly different from that of a usual care approach, the effect was considered null. ( c ) Three studies evaluated multidisciplinary experiences in the context of disease control and compliance to therapy [ 12 ], access to healthcare services [ 15 , 23 ], or attribution of a neuropsychiatric event to SLE [ 20 ].…”

“…Cases of small newborns for gestational age (SGA) occurred more frequently in SLE women than in controls (23% vs. 4.2%, p < 0.0001) but disproportionately between active and inactive If a comparator group was absent or the effect of MD was not significantly different from that of a usual care approach, the effect was considered null. (c) Three studies evaluated multidisciplinary experiences in the context of disease control and compliance to therapy [12], access to healthcare services [15,23], or attribution of a neuropsychiatric event to SLE [20].…”

The Impact of an Integrated Care Management Program on Acute Care Use and Outpatient Appointment Attendance Among High‐Risk Patients With Lupus

“…During the first 2 years of IQ‐LUPUS, participants achieved a reduction in hospital admissions, 30‐day readmissions, and missed appointment rates. In another recently published study, investigators identified patients with SLE who were admitted to the hospital for any reason and sent a templated message to the rheumatology clinic nurses at discharge ( 23 ). This message prompted the nurses to contact the patient to assist with care coordination and education.…”