Disease Outcomes and Care Fragmentation Among Patients With Systemic Lupus Erythematosus

Abstract

Objective: To examine the impact of care fragmentation across multiple health care institutions on disease outcomes in patients with systemic lupus erythematosus (SLE). Methods: Using the Chicago HealthLNK Data Repository, an assembly of electronic health records from 6 institutions, we identified patients with SLE, using International Classification of Diseases, Ninth Revision (ICD-9) codes, whose care was delivered at more than 1 organization. We examined whether patients had severe infections or comorbidities (ICD-9 code defined) that indicated SLE-induced damage. T-tests and chi-square tests were used to examine differences between fragmentation groups. Logistic regression was used to assess factors contributing to the occurrence of disease outcomes. Results: We identified 4,276 patients with SLE. A total of 856 (20%) received care from more than 1 health care institution. African American patients and patients with public insurance were more likely to experience care fragmentation compared to white and private insurance patients (odds ratio [OR] 1.66, 95% confidence interval [95% CI] 1.44–1.97 and OR 1.63, 95% CI 1.42–1.95). We identified increased risk of infections (OR 1.57, 95% CI 1.30–1.88), cardiovascular disease (OR 1.51, 95% CI 1.23–1.86), end-stage renal disease (OR 1.34, 95% CI 1.05–1.70), nephritis (OR 1.28, 95% CI 1.07–1.54), and stroke (OR 1.28, 95% CI 1.01–1.62) among patients with fragmented care, adjusted for age, sex, race, insurance status, length of followup time, and total visit count. Conclusion: In this cross-site cohort of SLE patients, care fragmentation is associated with increased risk of severe infection and comorbidities. These results suggest that improved health information exchange could positively impact outcomes for SLE patients.