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Abstract
Background and aims Gaps exist in SLE patient care at Ochsner Health System (Ochsner) related to both A) monitoring and management of comorbidities and treatment-related toxicities and, B) monitoring and management of disease activity. The uncovered gaps suggested a lack of well-defined systems of care in SLE within Ochsner that lead to a “looser” overall management of SLE patients than is optimal. Our hypothesis was that a more time-structured, IT-enhanced, and QI indicator-driven approach to SLE patient management would translate into a more frequent, more comprehensive, and guideline-adherent interaction with the patient (i.e. “tighter” management). This “tighter” management, we hypothesised, would manifest as improved patient outcomes.
Methods In order to prompt “tighter” management, we implemented the following interventional modalities:
Lupus Management Module: An SLE-specific management dashboard programmatically embedded into the Epic EHR system in use at Ochsner. The dashboard incorporates SLE-management-specific reminders, alerts, historical test result tracking, and customised assessment (SLEDAI, SLICC) programming.
Patient Campaigning: Identification of patients who are due for various SLE-specific testing or management activities and proactive contact in order to prompt an office visit.
Results We demonstrated a “tighter” management of SLE patients through statistically significant improvement in the rate of key SLE management behaviours (95% CI).
“Tighter” management, in turn, prompted statistically significant improvement in hospitalisation (85% CI).
Conclusions Time-structured, IT-enhanced, and QI indicator-driven interventional modalities prompted a more frequent, more comprehensive, and guideline-adherent point of care interaction with SLE patients (i.e. “tighter” management). “Tighter” management manifested as improved patient outcomes in the form of a diminished rate of hospitalisation among SLE patients.