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30-day Hospital Readmission of Georgia Lupus Registry Systemic Lupus Erythematosus Patients

René, Lexi Ojener (2016)
Master's Thesis (66 pages)
Committee Chair / Thesis Adviser: Moore, Renee H
Committee Members: Lim, S Sam ; Hanfelt, John
Research Fields: Biostatistics; Public health
Partnering Agencies: Emory University schools, faculty or affiliated programs
Keywords: Lupus
Program: Rollins School of Public Health, Biostatistics and Bioinformatics (Biostatistics)
Permanent url: http://pid.emory.edu/ark:/25593/rjsnv

Abstract

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease often afflicting younger minority women, in which a cure has yet to be found. This condition results in the body's immune system attacking healthy tissue, which potentially affects many parts of the body with mild or serious symptoms. Although there is no cure, SLE can be effectively treated with drugs. Due to the physical, as well as, psychological burdens that are associated with this disease, SLE inhibits people from completing their daily tasks; i.e., going to work/school. Because of this employment and insurance become difficult to maintain. Many SLE patients are insured by Medicare and Medicaid. Having SLE can lead to frequent utilization of health services with significant financial impact.

The Georgia Lupus Registry (GLR) conducted surveillance of SLE patients in Atlanta to develop a population- based registry geared towards better defining the incidence and prevalence of lupus. Supplementing the GLR data with Georgia Hospital Discharge Data provided insight into hospital utilization and readmission. Patients were categorized into three groups: never hospitalized, hospitalized with no readmission within 30 days and hospitalized with readmission within 30 days. Factors associated with 30-day hospital readmission among SLE patients were examined. Time to first hospital readmission within 30 days and associated baseline factors were analyzed.

Multivariable analyses showed that patients who live in census block groups with lower median income, and patients that meet the serositis (Odds Ratio [95% Confidence Interval]: 2.6 [1.4, 4.9]; p-value = 0.003) and renal disorder (OR [CI]: 1.95 [0.99, 3.83]; p-value = 0.05) American College of Rheumatology (ACR) criterion have higher odds of readmission within 30 days. Per $1,000 increase in median income, the odds of readmission is 0.98 [CI: 0.97, 0.99] times higher (p = 0.004). Multivariable survival analyses, omitting patients that were hospitalized with no readmission within 30 days, showed that patients who live in census block groups with lower income, and patients that meet the serositis ACR criterion (Hazard Ratio [CI]: 2.0 [1.3, 3.1]; p-value = 0.002) are at higher risk of readmission within 30 days. Per $1,000 increase in median income, the hazards ratio of readmission is 0.99 [CI: 0.98, 0.995] times higher (p = 0.003).

Table of Contents

1 Background

2 Methods

2.1 Data Source and Population

2.1.0.1 Aim 1: Data analytics

2.2 Measures

2.2.1 Outcome Variables

2.2.1.1 Prevalence

2.2.1.2 Time-to-event measures

2.2.1.3 Independent Variables

2.2.1.4 Derived Variables

2.2.2 Statistical Analysis

2.2.2.1 Aim 2: Descriptive statistics of adult GLR SLE incident patients

2.2.2.2 Aim 3: 30- day hospital readmission prevalence and associated factors

2.2.2.3 Aim 4: Time to first hospital readmission within 30 days

3 Results

4 Discussion

4.1 Limitations

4.2 Future Work

5 References

6 Appendix

6.1 Tables

6.2 Figures

Files

application/pdf Master's Thesis 66 pages (1.2 MB) [Access copy of Master's Thesis]
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