Lupus Patients Treated at Different Healthcare Facilities Have Worse Outcomes, Study Shows

Patients who have their lupus treated at more than one care facility are at higher risk of developing severe infections and other diseases, a study indicates.

The researchers called the tendency to go to more than one institution “fragmentation of treatment.”

Their study, “Disease Outcomes and Care Fragmentation among Patients with Systemic Lupus Erythematosus,” was published in the journal Arthritis Care & Research.

Lupus affects a range of the body’s systems. By its very nature then, it may require care from different specialists, many of whom are likely to be at different locations.

Making sure each care provider obtains a complete picture of a lupus patient’s needs requires exchanging information.

The problem is that while the vast majority of patient records are computerized, many care facilities failed to share it with each other.

Ninety-seven percent of hospitals and 83 percent of clinics have computerized patient records. They are comprehensive, with information on test results, patient care, outcomes, and billing codes.

If the information is not shared from provider to provider, however, what one provider sees will be only a portion of the total care that a patient has been receiving.

Few studies have focused on whether care at a number of facility affects the outcomes of those with a chronic disease. And no research had examined this issue in lupus patients.

This prompted a team of researchers to see if they could find a link between treatment fragmentation and lupus outcomes. They used the Chicago HealthLNK repository, a database that covers six large healthcare institutions in the city, to find patients treated at more than one facility.

Then they examined whether these patients developed severe infections or other diseases. Either would suggest a worse outcome, the team contended.

They discovered that 20 percent of the 4,276 lupus patients in the database had been treated at more than one facility. African-Americans and patients on public health insurance programs such as Medicare experienced care fragmentation at a 66 percent higher rate than whites or those who had private insurance, the team found.

Patients who had fragmented care were 57 percent more likely to develop infections and 51 percent more likely to develop a cardiovascular disease than those treated at only one facility, researchers said. Fragmented-care patients were also 34 percent more likely to develop an end-stage kidney disease. And their risk of developing either a kidney condition known as nephritis or having a stroke was 28 percent higher.

The results held when researchers adjusted for factors such as age, sex, race, insurance status, length of follow-up time, and number of visits. The team concluded that care fragmentation does increase the risk of lupus patients developing severe infections or another disease.

“Our data suggests that care fragmentation plays an independent role in increasing the frequency of disease-related morbidity damage in the SLE [lupus] patients from an urban environment, and worsens existing disparities already experienced by African-American patients and patients who are the beneficiaries of public insurance,” the researchers wrote. “Combined with previous research suggesting that existing damage is a predictor of future damage accrual for SLE patients, our study suggests that improving care coordination and access to a more complete set of medical record data may be a key strategy for improving health outcomes for SLE patients.”