It is estimated that at least 25 percent of all individuals with lupus are hospitalized each year. These hospitalizations tend to be associated with significant morbidity and mortality and are costly for the health care system. The U.S. Agency for Healthcare Research and Quality (AHRQ) developed a set of prevention quality indicators which they defined as conditions that “should be treatable on an outpatient basis, or that could be less severe if treated early and appropriately.” The AHRQ has used this set of “ambulatory care sensitive conditions” to identify populations at risk for hospitalization and to better understand the breakdown of health care services for these vulnerable groups. Examples of these conditions include diabetic complications, pulmonary disease (e.g. asthma) exacerbations, and pyelonephritis.
We aimed to develop a set of lupus-specific preventable conditions for which high quality, sustained outpatient rheumatologic care could potentially 1) prevent the need for hospitalization or emergency department visits or 2) lead to early intervention that could prevent or minimize complications or the development of more severe disease. We assembled a team of 16 experts in lupus-related care, including adult and pediatric rheumatologists, a dermatologist, cardiologist, obstetrician/gynecologist, infectious disease physician, nephrologist and neurologist from nine academic medical centers across the United States. We used a modified Delphi technique to reach consensus after two anonymous survey rounds followed by a webinar with real-time discussion and voting.
The expert panel agreed upon 24 lupus-specific conditions that they identified as both highly preventable and very important on a population level. These conditions fell under four general categories: vaccine-preventable illnesses, medication-related complications, reproductive health-related complications, and lupus-associated comorbidities (see Table 1). Overall, with the guidance of our expert panel, we developed a set of lupus-specific potentially preventable conditions that will allow us to evaluate potential points of breakdown in healthcare delivery, particularly for vulnerable patient populations. Ultimately, our goal is to develop interventions that can improve the quality of ambulatory rheumatology care for the highest risk patients in order to reduce rates of hospitalizations for preventable conditions.