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Persistently Frequent Emergency Department Utilization among Persons with Systemic Lupus Erythematosus

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Lee J1,2, Lin J1, Suter LG1,3, Fraenkel L1,3. Arthritis Care Res (Hoboken). 2018 Oct 8. doi: 10.1002/acr.23777. [Epub ahead of print]


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1 Yale University School of Medicine, New Haven, CT, 06520.

2 University of Michigan, Ann Arbor, MI, 48109.

3 VA Connecticut Healthcare System, West Haven, Connecticut, 06516.


OBJECTIVE: To evaluate SLE patients who persistently frequent the ED to identify opportunities to improve outpatient care.

METHODS: We conducted a retrospective study of SLE patients who frequented the ED for ≥3 visits in a calendar year from 2013-2016. Persistent users met criteria for frequent use for at least 2 out of the 4 years, and limited users for 1 out of the 4 years. Each ED encounter was categorized as; SLE-, infection-, pain- related, or "other". We compared ED use between persistent and limited users, and analyzed factors associated with pain-related encounters among persistent users through multivariate logistic regression.

RESULTS: We identified 77 participants having 1143 encounters as persistent users, and 52 participants having 335 encounters as limited users. Persistent users accounted for 77% of ED use by SLE patients who frequented the ED. Pain-related ED visits were more common among persistent users (32%) than limited users (18%). Among persistent users, most pain-related encounters were discharged from the ED (69%) or within 48 hours of admission (20%). Persistent users with pain-related encounters accounting for >10% of ED use, were more likely to be obese, have fewer comorbid conditions, and be on LTOT.

CONCLUSION: Pain is major cause of ED use. SLE patients persistently utilizing the ED for pain are likely to be non-critically ill, as evidenced by frequent discharges from the ED and short stay admissions. SLE patients who persistently frequent the ED for pain represent a viable target for interventions to improve outpatient quality of care.