Severity of illness in patients with systemic lupus erythematosus hospitalized at academic medical centers

Abstract

Objective: To compare the severity of illness of patients with systemic lupus erythematosus (SLE) between those hospitalized at academic medical centers and those hospitalized at community hospitals.

Methods: In this population based cross-sectional survey, data on all hospitalizations of patients with SLE in California, New York, and Pennsylvania in 2000 were obtained from discharge abstracts submitted by acute care hospitals to state health planning agencies. Patients hospitalized at one of 36 academic medical centers in these states (N = 2072) were compared to patients hospitalized at community hospitals (N = 9373). The primary measures of severity of illness were the SLE Comorbidity Index, a weighted index of SLE manifestations and comorbid medical conditions based on discharge diagnoses, and long lengths of stay, defined as stays that exceeded the 90th percentile of hospital stays in the same diagnosis-related group in the United States.

Results: Compared to patients at community hospitals, patients at academic medical centers had substantially higher scores on the SLE Comorbidity Index (odds ratio for each 1-point increase 1.27, 95% confidence interval 1.15-1.40, p < 0.0001) and were more likely to have long lengths of stay (OR 1.65, 95% CI 1.42-1.91, p < 0.0001). Patients at academic medical centers also had higher scores on the SLE Comorbidity Index (OR for each 1-point increase 1.16, 95% CI 1.07-1.27, p = 0.0002) and were more likely to have long lengths of stay (OR 1.27, 95% CI 1.08-1.49, p = 0.004) compared to patients at large (> or = 300 beds) community hospitals in the same metropolitan areas. Results for the SLE Comorbidity Index were similar in the subset of patients with SLE as the primary discharge diagnosis.

Conclusion: Patients with SLE hospitalized at academic medical centers are generally more severely ill than those hospitalized at community hospitals, including large community hospitals in the same area.