title: Centre-related variability in hospital admissions of patients with spondyloarthritis.
abstract: The aim of this study was to explore the variability in hospital admissions of patients with spondyloarthritis (SpA) in Spain, and the centre factors that may influence that variability. Descriptive cross-sectional study, part of the emAR II study, performed in Spain (2009-2010). Health records of patients with a diagnosis of SpA and at least one visit to the rheumatology units within the previous 2 years were reviewed. Variables related to hospital admissions, to the SpA, and to the patient and centre were collected. A multilevel logistic regression analysis of random intercept with non-random slopes was performed to assess variability between centres. From 45 centres, 1168 patients' health records were reviewed. Main SpA forms were ankylosing spondylitis (55.2 %) and psoriatic arthritis (22.2 %). A total of 248 admissions were registered for 196 patients (19.2 %, n = 1020). An adjusted variability of 17.6 % in hospitalizations between centres was noted. The following hospital-related factors showed a significant association with admissions: the total number of admissions of the centre, the existence of electronic admission, and the availability of ultrasound in rheumatology. However, these factors only explained 42.9 % of the inter-centre variability. The risk of a patient with SpA of being admitted could double (median OR 2.09), depending on the hospital where the patient was being managed. Hospital admissions of patients with SpA varied between hospitals due to centre characteristics. Further studies are needed to ascertain which specific factors may be causing the variation, as studied variables explained less than half of the variability.
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Calle Pintor Baeza 12, 03010, Alicante, Spain. drmarianoandres@gmail.com.
authors.forename: Mariano
authors.identifier: http://orcid.org/0000-0002-0219-9055
authors.initials: M
authors.lastname: Andrés
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: Sivera
authors.affiliation: Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain.
authors.forename: Sabina
authors.initials: S
authors.lastname: Pérez-Vicente
authors.affiliation: Instituto de Investigación Musculo-esquelética (inMusc), Madrid, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Calle Pintor Baeza 12, 03010, Alicante, Spain.|Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Vela
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012219:Rheumatology; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000175:diagnosis / Q000628:therapy*
keywords: Ankylosing spondylitis; Hospital admission; Spondyloarthritis; Variability