Associations of retention in care by visits or lupus-specific labs with acute care among young adults: A medicare cohort study.

ObjectiveWhile quality lupus care is associated with lower lupus-related damage, the impact of access and process quality measures on other lupus outcomes remains unclear. Given high acute care in young adults, our objective was to evaluate two process quality measures, visit-based retention in lupus care and receipt of lupus-specific serologic testing, and associations with subsequent acute care use.MethodsThis cohort study used a 20% national sample of young adult (ages 18-35) Medicare beneficiaries with lupus to first measure visit-based retention in rheumatology care and receipt of ≥1 complement or dsDNA test over 1 year. Acute care use (Emergency Department visits and hospitalizations) was then assessed in the subsequent 6 months. Associations of visit-based retention and serologic testing with acute care were evaluated with Cox regressions.ResultsAmong 1036 young adults with lupus, acute care use was very high - nearly 60% at 6 months. Observed acute care-free survival time was longer in patients who had visit-based retention (154 vs 104 days, p = 0.02) or serologic testing (166 vs 101 days, p = 0.002). Only 28% of beneficiaries had serologic testing, but this was associated with 21% lower incidence of acute care (aHR 0.79, 95% CI 0.65, 0.97) after adjustment; visit-based retention was not associated with acute care after adjustment.ConclusionReceipt of complement or dsDNA antibody testing, a lupus-specific care quality indicator, was associated with reduced acute care use in young adults. Improving lupus care quality measures, like complement or dsDNA testing, may improve lupus outcomes including reduced acute care use.