To identify a high-need, high-cost (HNHC) group among hospitalized lupus patients and compare clinical and social factors of the HNHC group with other lupus patients.
All hospitalizatins for lupus to a tertiary care center over a 3-year period were recorded. The number of admissions, 30-day readmissions, length of stay (LOS) and cost of admissions were compared for high-risk patients with all other hospitalized lupus patients (OHLP) during this period. We then compared clinical measures - dsDNA, complements, BMI, SLICC damage index (SDI) and comorbidity index (CMI), for the HNHC cohort with the OHLP group. We additionally differentiated social factors- age, race/ethnicity, poverty and medication adherence between the two groups.
A total of 202 patients with lupus accounted for 467 hospitalizations over the study period. The total cost of admissions was $13,192,346. Forty-four patients had significantly higher admissions, 30-day readmissions and LOS. Furthermore, the cost for this group was 6-fold that for OHLP, confirming the presence of a HNHC cohort. The HNHC group had significantly higher dsDNA, SDI and CMI compared with the OHLP. Infections were the most common cause for admission for both groups. The HNHC group were more likely to be African American, younger, diagnosed with lupus at an earlier age, have lower medication adherence and significantly more likely to live in areas of poverty.
A small group of lupus patients, HNHC account for most of the hospitalizations and cost. The HNHC group has both social and clinical factors significantly different from other lupus patients.