Disease Outcomes and Care Fragmentation Among Patients With Systemic Lupus Erythematosus

Theresa L. Walunas, Kathryn L. Jackson, Anh H. Chung, Karen A. Mancera-Cuevas, Daniel L. Erickson, Rosalind Ramsey-Goldman, Abel Kho

Research output: Contribution to journalArticle

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Abstract

Objective: To examine the impact of care fragmentation across multiple health care institutions on disease outcomes in patients with systemic lupus erythematosus (SLE). Methods: Using the Chicago HealthLNK Data Repository, an assembly of electronic health records from 6 institutions, we identified patients with SLE, using International Classification of Diseases, Ninth Revision (ICD-9) codes, whose care was delivered at more than 1 organization. We examined whether patients had severe infections or comorbidities (ICD-9 code defined) that indicated SLE-induced damage. T-tests and chi-square tests were used to examine differences between fragmentation groups. Logistic regression was used to assess factors contributing to the occurrence of disease outcomes. Results: We identified 4,276 patients with SLE. A total of 856 (20%) received care from more than 1 health care institution. African American patients and patients with public insurance were more likely to experience care fragmentation compared to white and private insurance patients (odds ratio [OR] 1.66, 95% confidence interval [95% CI] 1.44–1.97 and OR 1.63, 95% CI 1.42–1.95). We identified increased risk of infections (OR 1.57, 95% CI 1.30–1.88), cardiovascular disease (OR 1.51, 95% CI 1.23–1.86), end-stage renal disease (OR 1.34, 95% CI 1.05–1.70), nephritis (OR 1.28, 95% CI 1.07–1.54), and stroke (OR 1.28, 95% CI 1.01–1.62) among patients with fragmented care, adjusted for age, sex, race, insurance status, length of followup time, and total visit count. Conclusion: In this cross-site cohort of SLE patients, care fragmentation is associated with increased risk of severe infection and comorbidities. These results suggest that improved health information exchange could positively impact outcomes for SLE patients.

LanguageEnglish (US)
Pages1369-1376
Number of pages8
JournalArthritis Care and Research
Volume69
Issue number9
DOIs
StatePublished - Sep 1 2017

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Systemic Lupus Erythematosus
International Classification of Diseases
Odds Ratio
Confidence Intervals
Insurance
Comorbidity
Infection
Delivery of Health Care
Insurance Coverage
Nephritis
Electronic Health Records
Chi-Square Distribution
African Americans
Chronic Kidney Failure
Patient Care
Cardiovascular Diseases
Logistic Models
Stroke
Organizations

ASJC Scopus subject areas

  • Rheumatology

Cite this

Walunas, Theresa L. ; Jackson, Kathryn L. ; Chung, Anh H. ; Mancera-Cuevas, Karen A. ; Erickson, Daniel L. ; Ramsey-Goldman, Rosalind ; Kho, Abel. / Disease Outcomes and Care Fragmentation Among Patients With Systemic Lupus Erythematosus. In: Arthritis Care and Research. 2017 ; Vol. 69, No. 9. pp. 1369-1376
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abstract = "Objective: To examine the impact of care fragmentation across multiple health care institutions on disease outcomes in patients with systemic lupus erythematosus (SLE). Methods: Using the Chicago HealthLNK Data Repository, an assembly of electronic health records from 6 institutions, we identified patients with SLE, using International Classification of Diseases, Ninth Revision (ICD-9) codes, whose care was delivered at more than 1 organization. We examined whether patients had severe infections or comorbidities (ICD-9 code defined) that indicated SLE-induced damage. T-tests and chi-square tests were used to examine differences between fragmentation groups. Logistic regression was used to assess factors contributing to the occurrence of disease outcomes. Results: We identified 4,276 patients with SLE. A total of 856 (20{\%}) received care from more than 1 health care institution. African American patients and patients with public insurance were more likely to experience care fragmentation compared to white and private insurance patients (odds ratio [OR] 1.66, 95{\%} confidence interval [95{\%} CI] 1.44–1.97 and OR 1.63, 95{\%} CI 1.42–1.95). We identified increased risk of infections (OR 1.57, 95{\%} CI 1.30–1.88), cardiovascular disease (OR 1.51, 95{\%} CI 1.23–1.86), end-stage renal disease (OR 1.34, 95{\%} CI 1.05–1.70), nephritis (OR 1.28, 95{\%} CI 1.07–1.54), and stroke (OR 1.28, 95{\%} CI 1.01–1.62) among patients with fragmented care, adjusted for age, sex, race, insurance status, length of followup time, and total visit count. Conclusion: In this cross-site cohort of SLE patients, care fragmentation is associated with increased risk of severe infection and comorbidities. These results suggest that improved health information exchange could positively impact outcomes for SLE patients.",
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Disease Outcomes and Care Fragmentation Among Patients With Systemic Lupus Erythematosus. / Walunas, Theresa L.; Jackson, Kathryn L.; Chung, Anh H.; Mancera-Cuevas, Karen A.; Erickson, Daniel L.; Ramsey-Goldman, Rosalind; Kho, Abel.

In: Arthritis Care and Research, Vol. 69, No. 9, 01.09.2017, p. 1369-1376.

Research output: Contribution to journalArticle

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AU - Walunas,Theresa L.

AU - Jackson,Kathryn L.

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N2 - Objective: To examine the impact of care fragmentation across multiple health care institutions on disease outcomes in patients with systemic lupus erythematosus (SLE). Methods: Using the Chicago HealthLNK Data Repository, an assembly of electronic health records from 6 institutions, we identified patients with SLE, using International Classification of Diseases, Ninth Revision (ICD-9) codes, whose care was delivered at more than 1 organization. We examined whether patients had severe infections or comorbidities (ICD-9 code defined) that indicated SLE-induced damage. T-tests and chi-square tests were used to examine differences between fragmentation groups. Logistic regression was used to assess factors contributing to the occurrence of disease outcomes. Results: We identified 4,276 patients with SLE. A total of 856 (20%) received care from more than 1 health care institution. African American patients and patients with public insurance were more likely to experience care fragmentation compared to white and private insurance patients (odds ratio [OR] 1.66, 95% confidence interval [95% CI] 1.44–1.97 and OR 1.63, 95% CI 1.42–1.95). We identified increased risk of infections (OR 1.57, 95% CI 1.30–1.88), cardiovascular disease (OR 1.51, 95% CI 1.23–1.86), end-stage renal disease (OR 1.34, 95% CI 1.05–1.70), nephritis (OR 1.28, 95% CI 1.07–1.54), and stroke (OR 1.28, 95% CI 1.01–1.62) among patients with fragmented care, adjusted for age, sex, race, insurance status, length of followup time, and total visit count. Conclusion: In this cross-site cohort of SLE patients, care fragmentation is associated with increased risk of severe infection and comorbidities. These results suggest that improved health information exchange could positively impact outcomes for SLE patients.

AB - Objective: To examine the impact of care fragmentation across multiple health care institutions on disease outcomes in patients with systemic lupus erythematosus (SLE). Methods: Using the Chicago HealthLNK Data Repository, an assembly of electronic health records from 6 institutions, we identified patients with SLE, using International Classification of Diseases, Ninth Revision (ICD-9) codes, whose care was delivered at more than 1 organization. We examined whether patients had severe infections or comorbidities (ICD-9 code defined) that indicated SLE-induced damage. T-tests and chi-square tests were used to examine differences between fragmentation groups. Logistic regression was used to assess factors contributing to the occurrence of disease outcomes. Results: We identified 4,276 patients with SLE. A total of 856 (20%) received care from more than 1 health care institution. African American patients and patients with public insurance were more likely to experience care fragmentation compared to white and private insurance patients (odds ratio [OR] 1.66, 95% confidence interval [95% CI] 1.44–1.97 and OR 1.63, 95% CI 1.42–1.95). We identified increased risk of infections (OR 1.57, 95% CI 1.30–1.88), cardiovascular disease (OR 1.51, 95% CI 1.23–1.86), end-stage renal disease (OR 1.34, 95% CI 1.05–1.70), nephritis (OR 1.28, 95% CI 1.07–1.54), and stroke (OR 1.28, 95% CI 1.01–1.62) among patients with fragmented care, adjusted for age, sex, race, insurance status, length of followup time, and total visit count. Conclusion: In this cross-site cohort of SLE patients, care fragmentation is associated with increased risk of severe infection and comorbidities. These results suggest that improved health information exchange could positively impact outcomes for SLE patients.

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Walunas TL, Jackson KL, Chung AH, Mancera-Cuevas KA, Erickson DL, Ramsey-Goldman R et al. Disease Outcomes and Care Fragmentation Among Patients With Systemic Lupus Erythematosus. Arthritis Care and Research. 2017 Sep 1;69(9):1369-1376. Available from, DOI: 10.1002/acr.23161