title: Frequent use of the emergency department among persons with systemic lupus erythematosus.
abstract: OBJECTIVE
  To describe characteristics of systemic lupus erythematosus (SLE) patients who are frequent users of the emergency department and to identify predictors of frequent emergency department use.
  
  
  METHODS
  Data for this study were derived from the University of California, San Francisco Lupus Outcomes Study, a large cohort of persons with SLE who undergo annual structured interviews. Participants were categorized into 1 of 3 levels of emergency department utilization: nonusers (no visits in the preceding year), occasional users, (1-2 visits), and frequent users (> or =3 visits). We compared characteristics of the 3 groups and determined predictors of frequent emergency department use (> or =3 visits) using multivariate logistic regression, adjusting for a variety of potential confounding covariates.
  
  
  RESULTS
  Of 807 study participants, 499 (62%) had no emergency department visits; 230 (28%) had occasional emergency department visits (1-2 visits); and 78 (10%) had frequent (> or =3 visits) emergency department visits. Frequent users were younger, less likely to be employed, and less likely to have completed college. They also had greater disease activity, worse general health status, and more depressive symptoms. Frequent emergency department users were more likely to have Medicaid as their principal insurance. In multivariate logistic regression, older age predicted a lower likelihood of frequent emergency department visits, whereas greater disease activity and having Medicaid insurance predicted a higher likelihood of frequent emergency department visits.
  
  
  CONCLUSIONS
  In persons with SLE, greater disease activity and Medicaid insurance are associated with more frequent emergency department use.
authors.affiliation: Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco, CA 94143-0920, USA. pantelis.panopalis@mail.mcgill.ca
authors.forename: Pantelis
authors.initials: P
authors.lastname: Panopalis
authors.forename: Joann Zell
authors.initials: JZ
authors.lastname: Gillis
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Aimee
authors.initials: A
authors.lastname: Hersh
authors.forename: Laura
authors.initials: L
authors.lastname: Julian
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Criswell
authors.forename: Patricia
authors.initials: P
authors.lastname: Katz
authors.forename: Edward
authors.initials: E
authors.lastname: Yelin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D012495:San Francisco; D012720:Severity of Illness Index; D014481:United States
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