Young adults with systemic lupus erythematosus (SLE) on Medicare are more likely to be readmitted to the hospital
within 30 days compared to age-matched controls without SLE, explains Christie M. Bartels, MD, MS. “However, factors increasing readmission risk for younger patients are unclear. Given patients with lupus are younger than those with other high readmission risk conditions like heart failure or COPD, their elevated risk is overlooked.”

For a study published in The Journal of Rheumatology, Dr. Bartels and colleagues aimed to determine predictors of rehospitalization among young patients with lupus to aid clinicians in developing strategies to reduce readmissions in this population.

Young Patients With Lupus on Medicare Have Greater Comorbidities

“We wanted to quantify the risk for 30-day rehospitalization for Medicare patients with lupus compared with patients without lupus by age strata to see if risk factors differed by age group,” first author Maria Schletzbaum, PhD, says. “Using a national Medicare sample with Geo linked information on a patient’s socioeconomic status and comorbid conditions, we created statistical models for all ages, as well as age-specific models, to predict rehospitalization. This allowed us to compare the effect of common factors between age groups as well as specific factors for each age group.”

The study team observed that young patients with lupus on Medicare are more likely to live in socioeconomically disadvantaged neighborhoods and have more comorbidities.

“Among all patients with lupus, younger age, comorbidities, and a longer hospital stay all increased the risk for being readmitted,” Dr. Bartels says. “Given that more than one in three young adults with lupus on Medicare was readmitted to the hospital within 30 days of discharge, they likely need additional support and closer follow-up.”

Rehospitalization & Mortality Rates

Among Medicare beneficiaries, the 30-day rehospitalization risk was greatest for young patients—36% for young patients with SLE compared with 26% in young adults without lupus. Among older adults with SLE, the rehospitalization risk was 20% (Figure).

A Prompt Follow-Up Visit in a Clinic or Virtually Is Crucial

Many young adult patients with lupus who are Medicare beneficiaries may require additional support after hospital discharge to avoid readmission, according to Dr. Bartels and colleagues. “A prompt follow-up visit with a physician in a clinic or virtually is key,” Dr. Bartels says. “Collaboration with social workers or case managers can help connect these high-risk patients to additional support services such as home healthcare, peer support programs, and resources to address social determinants of health. Rheumatologists and primary care physicians could also work together to develop transitional care support for patients with lupus who are at high predicted readmission risk based on the models presented in this study.”

The study team concurs that there is still much work to do to reduce hospitalization time for patients with lupus. “Our research group is presently evaluating the impact of timely post discharge follow-up with primary care and
rheumatology clinicians on reducing readmissions,” Dr. Bartels says. “Additionally, we are investigating the effect of regular longitudinal rheumatology visits and lupus-specific lab monitoring on preventing hospitalization. Readmission reduction programs should be tailored for patients after learning what factors contribute to readmission from the perspectives of patients living with lupus.”