Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Georgia Lupus Registry: Health Care Utilization Rises during the Transition from Pediatric to Adult Systemic Lupus Erythematosus (SLE) Care.

Lim3,  S. Sam, Bao1,  Gaobin, Vogler4,  Larry B., Drenkard2,  Cristina M.

Emory University
Emory University, Atlanta, GA
Emory University, Atlanta, GA
Emory University School of Medicine, Atlanta, GA

Background:

Some studies have reported childhood onset SLE as being more severe than in adults. Therefore, children with SLE may be at high risk for entering adulthood with disease related morbidity, damage, and disability. Furthermore, medical and psychosocial barriers can complicate the transition from pediatric to adult care. The aim of this study is to describe how health care utilization may change during this transition period.

Methods:

The Georgia Lupus Registry is a population-based registry designed to estimate the incidence and prevalence of SLE in Atlanta, Georgia, from 2002 through 2004. Case-finding utilizes multiple sources. As a public health project, trained abstractors are able to document nearly 250 demographic and clinical elements from medical records of potential SLE patients without having to obtain consent. All facilities with potential pediatric SLE patients have been abstracted. All patients met the following case definition: having either >=4 ACR criteria or 3 ACR criteria with a diagnosis of SLE by a pediatric rheumatologist at age <=18 years. The validated SLE patients were matched to the 1999–2004 Georgia Hospital Discharge Database, which captures all emergency room visits (ERV) and hospital admissions (HA) throughout the state and assigns a standardized direct cost to that care.

Results:

37 with childhood-onset SLE turned 19 years old between 1/1/1999 and 12/31/2004. 23 of these recorded at least one ERV or HA during this period (217 total visits) and had an average of 6.3 ACR criteria. The remaining 14 patients did not record an ERV or HA and averaged 5.1 ACR criteria.

 before turning 19 years old (person-years = 104)after turning 19 years old (person-years = 108) 
 ERVHAERVHAP-value*
Visits, total38 117 <.0001
  21 410.01
Visits, Gender
  Male (n = 4)1 13 0.001
  0 5
  Female (n = 19)37 104 <.0001
  21 360.047
Visits, Race
  Black (n = 20)33 103 <.0001
  19 390.009
  White (n = 3)5 14 0.039
  2 21.00
Cost per Visit, $ Mean11858 8978 0.37
  13570 135980.41
  Male (mean)2528-473222686 
  Female (mean)1211013570950912335 
  Black (mean)1170913269988413936 
  White (mean)128431643223186995 
Duration, days
  Median1 1 0.21
  7 30.002
  Male (mean)2.0-1.57.0 
  Female (mean)4.37.13.03.7 
  Black (mean)4.47.23.04.2 
  White (mean)3.47.01.51.5 
*Based on Wilcoxon Rank-Sum Test

Conclusions:

The health care utilization burden of childhood-onset SLE is significant. With nearly equal amount of person-time follow-up before and after turning 19 years old, there is a striking increase in the number of ERV (tripling from 38 to 117) and HA (doubling from 21 to 41). This may signal the need to better coordinate the transfer of care for these patients. Access to care may be a factor as children without resources lose Medicaid coverage when turning 19. Further research is needed to elucidate the modifiable factors driving this change.

To cite this abstract, please use the following information:
Lim, S. Sam, Bao, Gaobin, Vogler, Larry B., Drenkard, Cristina M.; The Georgia Lupus Registry: Health Care Utilization Rises during the Transition from Pediatric to Adult Systemic Lupus Erythematosus (SLE) Care. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :790
DOI: 10.1002/art.28558

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