Avoidable hospitalizations in patients with systemic lupus erythematosus

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Abstract
Objective Avoidable hospitalizations are hospitalizations for indications that could have been prevented by prompt and appropriate outpatient treatment. Avoidable hospitalizations thus serve as an indicator of poor access to, or underutilization of, medical care. This study examined risk factors for avoidable hospitalizations among patients with systemic lupus erythematosus (SLE). Methods Data were obtained on acute-care hospitalizations in a population-based sample of 8,670 patients with SLE age ≥18 years hospitalized in New York state in 2000, 2001, and 2002. Hospitalizations were classified as avoidable based on the principal indication for hospitalization. Patient demographic and hospital characteristics were examined as risk factors. Results Of 16,751 hospitalizations, 2,123 (12.7%) were for avoidable conditions, most commonly pneumonia, congestive heart failure, and cellulitis. The likelihood of avoidable hospitalizations increased progressively with age, was higher among patients with Medicare than among those with other types of medical insurance, and was higher among those of lower socioeconomic status. Hospitalizations for avoidable conditions were less likely at hospitals that admitted larger numbers of patients with SLE than at hospitals that admitted fewer patients with SLE. Conclusion Avoidable hospitalizations occur more commonly among older and poorer patients, suggesting that these patients have more difficulty accessing care. The lower risk of avoidable hospitalizations at centers that admit large numbers of patients with SLE may be due to patient selection or may represent better outpatient care by physicians at these centers.