Top

16-08-2018 | Systemic lupus erythematosus | Article

Effects of transitional care on self-care, readmission rates, and quality of life in adult patients with systemic lupus erythematosus: a randomized controlled trial

Journal: Arthritis Research & Therapy

Authors: Xia Xie, Yuqing Song, Hui Yang, Anliu Nie, Hong Chen, Ji-ping Li

Publisher: BioMed Central

Abstract

Background

Lack of adequate self-care, frequent admissions, and poor quality of life are common and serious problems in adult patients with systemic lupus erythematosus (SLE). Some studies have revealed that transitional care is effective in improving self-care and quality of life as well as reducing rehospitalization rates. However, limited studies explored its effects in adult patients with SLE. Therefore, we performed a study to examine the effects of transitional care on self-care, readmission rates, and quality of life in adult patients with SLE.

Methods

This study was a single-center, single-blind, and parallel-group randomized controlled trial comparing transitional care with usual care in SLE patients from a university hospital in China. Evaluations were conducted at baseline before discharge and at 3 months after discharge by using hospital readmission rate, the Exercise of Self-Care Agency Scale, and the Medical Outcomes Study Short Form 36-item Health Survey for self-care and quality of life. Data were collected between June and December 2016.

Results

Compared with the usual care group, the transitional care group reported significantly greater improvement in self-care and quality of life. Additionally, the 30-day readmission rate for the patients in the transitional care group was significantly lower than in the usual care group, and this effect remained significant at 60 and 90 days after patient discharge.

Conclusion

This study shows that transitional care improves self-care and quality of life in adult patients with SLE and reduces readmissions. However, further studies are needed.

Trial registration

China clinical trial registry, ChiCTR-IPR-16007708. Registered January 5, 2016.

Rees F, Doherty M, Grainge M, Davenport G, Lanyon P, Zhang W. The incidence and prevalence of systemic lupus erythematosus in the UK, 1999-2012. Ann Rheum Dis. 2016;75:136–41.

Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part I. Arthritis Rheum. 2008;58:15–25.CrossRefPubMed

Yeh KW, Yu CH, Chan PC, Horng JT, Huang JL. Burden of systemic lupus erythematosus in Taiwan: a population-based survey. Rheumatol Int. 2013;33:1805–11.CrossRefPubMed

Zou YF, Feng CC, Zhu JM, Tao JH, Chen GM, Ye QL, et al. Prevalence of systemic lupus erythematosus and risk factors in rural areas of Anhui Province. Rheumatol Int. 2014;34:347–56. https://doi.org/10.1007/s00296-013-2902-1.CrossRefPubMed

Yurkovich M, Vostretsova K, Chen W, Aviña-Zubieta JA. Overall and cause specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis Care Res. 2014;66:608–16.CrossRef

Nikpour M, Urowitz MB, Ibanez D, Gladman DD. Frequency and determinants of flare and persistently active disease in systemic lupus erythematosus. Arthritis Rheum. 2009;61:1152–8.CrossRefPubMed

Lai JS, Beaumont JL, Jensen SE, Kaiser K, Van Brunt DL, Kao AH, et al. An evaluation of health-related quality of life in patients with systemic lupus erythematosus using PROMIS and neuro-QoL. Clin Rheumatol. 2017;36:555–62.CrossRefPubMed

Yazdany J, Marafino BJ, Dean ML, Bardach NS, Duseja R, Ward MM, et al. Thirty-day hospital readmissions in systemic lupus erythematosus: predictors and hospital- and state-level variation. Arthritis Rheum. 2014;66:2828–36.CrossRef

Teh CL, Chan GYL, Lee J. Systemic lupus erythematosus in a tertiary, east Malaysian hospital: admission, readmission and death. Int J Rheum Dis. 2008;11:24–9.CrossRef

10.

Khamashta MA, Bruce IN, Gordon C, Isenberg DA, Ateka-Barrutia O, Gayed M, et al. The cost of care of systemic lupus erythematosus (SLE) in the UK annual direct costs for adult SLE patients with active autoantibody-positive disease. Lupus. 2014;23:273–83.CrossRefPubMed

11.

Elixhauser A, Steiner C, Readmissions to US hospitals by diagnosis. Healthcare cost and utilization project (HCUP) statistical brief #153. Rockville: Agency for Healthcare Research and Quality; 2010. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf

12.

Anandarajah AP, Luc M, Ritchlin CT. Hospitalization of patients with systemic lupus erythematosus is a major cause of direct and indirect healthcare costs. Lupus. 2016;26:756–61.CrossRefPubMed

13.

Agborsangaya CB, Lau D, Lahtinen M, Cooke T, Johnson JA. Health-related quality of life and healthcare utilization in multimorbidity: results of a cross-sectional survey. Qual Life Res. 2013;22:791–9.CrossRefPubMed

14.

Khanna S, Pal H, Pandey RM, Handa R. The relationship between disease activity and quality of life in systemic lupus erythematosus. Rheumatology (Oxford). 2004;43:1536–40.CrossRef

15.

Sahebi A, Mohammadaliha J, Ansariramandi M, Naderi N. Investigation the relationship between self-care and readmission in patients with chronic heart failure. Res Cardiovasc Med. 2015;4:e25472.PubMedPubMedCentral

16.

Chiaranai C. Self-care and quality of life in patients with heart failure: Virginia Commonwealth University; 2007. https://scholarscompass.vcu.edu/etd/1417

17.

Guo XJ, Li L, Jiang MH. Present situation and influencing factors of self-care ability of patients with systemic lupus erythematosus. Chin J Mod Nurs. 2014;20:3582–5.

18.

Zirkzee EJ, Steup-Beekman GM, Schouffoer AA, Henquet SM, Caljouw MA, Huizinga TW, et al. Health care in systemic lupus erythematosus (SLE) the patient's perspective. Clin Rheumatol. 2014;33:1279–87.CrossRefPubMed

19.

Danoffburg S, Friedberg F. Unmet needs of patients with systemic lupus erythematosus. Behav Med. 2009;35:5–13.CrossRef

20.

Sullivan S. Development of a systemic lupus erythematosus knowledge questionnaire: the relationship among disease proximity, educational exposure, and knowledge: University of Wisconsin-Milwaukee; 2016. https://dc.uwm.edu/etd/1312

21.

Liu YF, Chen WJ, Xu WP, Huang JW, Chen QL. Effect of Omaha system-based extending nursing on diabetic patients’ self-care abilities. J Nurs. 2015;22:34–9.

22.

Berre ML, Maimon G, Sourial N, Guériton M, Vedel I. Impact of transitional care services for chronically ill older patients: a systematic evidence review. J Am Geriatr Soc. 2017;65:1597–1608.

23.

Yu DS, Lee DT, Stewart S, Thompson DR, Choi KC, Yu CM. Effect of nurse-implemented transitional care for Chinese individuals with chronic heart failure in Hong Kong: a randomized controlled trial. J Am Geriatr Soc. 2015;63:1583–93.CrossRefPubMed

24.

Clemente D, Leon L, Foster H, Carmona L, Minden K. Transitional care for rheumatic conditions in Europe: current clinical practice and available resources. Pediatr Rheumatol. 2017;15:49.CrossRef

25.

Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W. The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology (Oxford). 2017;56:1945–61.CrossRef

26.

Chow SK, Wong FK. A randomized controlled trial of a nurse-led case management programme for hospital-discharged older adults with co-morbidities. J Adv Nurs. 2014;70:2257–71.CrossRefPubMedPubMedCentral

27.

Holland DE, Vanderboom CE, Delgado AM, Weiss ME, Monsen KA. Describing pediatric hospital discharge planning care processes using the Omaha system. Appl Nurs Res. 2016;30:24–8.CrossRefPubMed

28.

The Omaha System. http://www.omahasystem.org/index.html. Accessed 6 Mar 2018.

29.

Jing XM, Jing YJ, Jing JY, Li Y, Mei XP. Evaluation of application effect of Omaha problem classification system in home visit of systemic lupus erythematosus patients. Chin Nurs Res. 2015;16:1957–60.

30.

Martin KS, Monsen KA, Bowles KH. The Omaha system and meaningful use: applications for practice, education, and research. Comput Inform Nurs. 2011;29:52–8.CrossRefPubMed

31.

Gladman DD, Ibanez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002;29:288–91.PubMed

32.

Kearney BY, Fleischer BJ. Development of an instrument to measure exercise of self-care agency. Res Nurs Health. 1979;2:25–34.CrossRefPubMed

33.

Wang HH, Laffrey SC. Preliminary development and testing of instruments to measure self-care agency and social support of women in Taiwan. Kaohsiung J Med Sci. 2000;16:459–67.PubMed

34.

Wang YB, Xu LY, Yang LS, Yang LM, Yang HR. Reliability and validity of Chinese version of the exercise of self-care agency scale in schizophrenia patients. J Clin Psychiatry. 2014;24:104–7.

35.

Stoll T, Gordon C, Burkhardt S, Richardson K, Malik J, Bacon PA, et al. Consistency and validity of patient administered assessment of quality of life by the MOS SF-36; its association with disease activity and damage in patients with systemic lupus erythematosus. J Rheumatol. 1997;24:1608–14.PubMed

36.

Hull CM. Assessing the impact of a transitional care program on symptom recognition and self-care in heart failure patients: The University of Arizona; 2016. https://hdl.handle.net/10150/622989

37.

Pulvirenti M, Mcmillan J, Lawn S. Empowerment, patient centred care and self-management. Health Expect. 2014;17:303–10.CrossRefPubMed

38.

Verhaegh KJ, MacNeil-Vroomen JL, Eslami S, Geerlings SE, de Rooij SE, Buurman BM. Transitional care interventions prevent hospital readmissions for adults with chronic illnesses. Health Aff (Millwood). 2014;33:1531–9.CrossRefPubMed

39.

Greenwald JL, Denham CR, Jack BW. The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process. J Patient Saf. 2007;3:97–106.CrossRef

40.

Gray DP, Evans P, Sweeney K, Lings P, Seamark D, Seamark C, et al. Towards a theory of continuity of care. J R Soc Med. 2003;96:160–6.CrossRefPubMedPubMedCentral

41.

Stamp KD, Machado MA, Allen NA. Transitional care programs improve outcomes for heart failure patients: an integrative review. J Cardiovasc Nurs. 2014;29:140–54.CrossRefPubMed

42.

Uijen AA, Bischoff EW, Schellevis FG, Bor HH, van den Bosch WJ, Schers HJ. Continuity in different care modes and its relationship to quality of life: a randomised controlled trial in patients with COPD. Br J Gen Pract. 2012;62:e422–8.CrossRefPubMedPubMedCentral