TY - JOUR
T1 - Disease Outcomes and Care Fragmentation Among Patients With Systemic Lupus Erythematosus
AU - Walunas, Theresa L.
AU - Jackson, Kathryn L.
AU - Chung, Anh H.
AU - Mancera-Cuevas, Karen A.
AU - Erickson, Daniel L.
AU - Ramsey-Goldman, Rosalind
AU - Kho, Abel
N1 - Funding Information:
The authors wish to thank the HealthLNK Data Repository, including Bala Hota, MD, Rush University Medical Center, Bill Galanter, MD, University of Illinois at Chicago Medical Center, and David Meltzer, MD, PhD, University of Chicago Hospitals and Clinic, for their support. In addition, the authors would like to thank Daniel Fort, PhD, Northwestern, and William Trick, MD, Cook County Health and Hospitals System, for their thoughtful review of the manuscript.
Publisher Copyright:
© 2016, American College of Rheumatology
PY - 2017/9
Y1 - 2017/9
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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U2 - 10.1002/acr.23161
DO - 10.1002/acr.23161
M3 - Article
C2 - 27899012
AN - SCOPUS:85027498914
SN - 2151-464X
VL - 69
SP - 1369
EP - 1376
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 9
ER -
