According to a study conducted at the Geisinger Medical Center in Danville, Pennsylvania, a significant portion of gout-related hospitalizations may be preventable. These findings were recently presented at the 2014 American College of Rheumatology Annual Meeting, November 14–19, in Boston, Massachusetts.
Gout is a form of inflammatory arthritis that causes sudden and severe pain, swelling, and tenderness. It occurs most often in the large joint of the big toe but can affect other joints including the feet, ankles, knees, hands, wrists, elbows as well as soft tissue and tendons. Gout occurs when the bodily waste product uric acid is deposited as needle-like crystals in the joints and/or soft tissues. An estimated 6.1 million Americans have experienced at least one gout attack.
Many people with gout experience recurrent flares and require hospitalization. Researchers with the Geisinger Medical Center recently questioned whether some of these flares and hospitalizations—and the accompanying costs—are preventable.
To determine how many gout-related hospitalizations at the Geisinger Medical Center might have been preventable, researchers evaluated 79 patients who had been discharged with a diagnosis of gout. Participants were hospitalized between 2009 and 2013.
The researchers considered admission to the hospital preventable if the patient was diagnosed with gout but without any associated illness or other condition that called for hospitalization. They also took into account history of gout, gout medication, risk factors for gout (including diabetes, cardiovascular disease, chronic kidney disease, diuretic or low-dose aspirin use), and blood levels of uric acid within one year before hospitalization (the goal is a uric acid level less than 6 milligrams per deciliter [mg/dL]).
Of the 79 patients discharged with gout and evaluated in the study, 56 were admitted to the hospital with gout. Thirty-five (70%) had a previous history of gout; the majority of whom (74%) saw a primary care doctor for the condition and 26% saw a rheumatology specialist. Twenty-one (42%) of participants had at least three risk factors for gout. Uric acid levels within one year before hospitalization were available for 23 patients; the majority (almost 80%) of these patients’ levels did not meet the goal of 6 mg/dL or lower. Fifteen of the participants were on long-term treatment for gout, but 33% weren’t following treatment as prescribed.
After analyzing the patients’ conditions and circumstances leading to hospitalization, the researchers determined that the majority of admissions—almost 90%—could have been prevented. They translated preventable admissions into 171 days of days in the hospital, with hospitalization costing a total of about $200,000 or about $4,000 per admission.
The researchers cited several explanations for the significantly high rate of admissions that could have been prevented. Though the American College of Rheumatology and the European League Against Rheumatism have published guidelines on the management of gout, they found that these recommendations were not followed. They also determined that a portion of the diagnoses of gout had not been confirmed by the presence of uric acid crystals. Furthermore, admission rates increased when patients went directly to the emergency room for care of gout (versus primary care or a specialist) and when patients didn’t take medication as prescribed.
These findings highlight the steps that both providers and patients can take to avoid preventable hospital admissions for treatment of gout. Given the costly nature of both emergency room care and hospital admission, this is an important aspect of improving care for patients with gout.
Reference: Sharma TS, Harrington TM, and Olenginski TP. Aim for Better Gout Control: A Retrospective Analysis of Preventable Hospital Admissions for Gout. Program and Abstracts of the American College of Rheumatology Annual Meeting 2014; November 14–19; Boston, Massachusetts. Abstract 2322.