Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises
Abstract Background Vaso‐occlusive crises (VOC) are the hallmark of sickle cell disease (SCD). Adults experiencing VOC often have high rates of unexpected healthcare utilization. We characterized prior and future healthcare utilization among adults hospitalized with VOC at an urban, academic medical...
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| Format: | Article |
| Language: | English |
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Wiley
2020-11-01
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| Series: | eJHaem |
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| Online Access: | https://doi.org/10.1002/jha2.84 |
| _version_ | 1797739976947924992 |
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| author | Angie Mae Rodday Kimberly S Esham Nicole Savidge Susan K Parsons |
| author_facet | Angie Mae Rodday Kimberly S Esham Nicole Savidge Susan K Parsons |
| author_sort | Angie Mae Rodday |
| collection | DOAJ |
| description | Abstract Background Vaso‐occlusive crises (VOC) are the hallmark of sickle cell disease (SCD). Adults experiencing VOC often have high rates of unexpected healthcare utilization. We characterized prior and future healthcare utilization among adults hospitalized with VOC at an urban, academic medical center. Methods We identified 449 VOC hospitalizations among 63 patients from 2013 to 2016. Patients were categorized based on receiving established care at the medical center and prior utilization: (a) not established (n = 21); (b) newly established (n = 10); (c) established with low utilization in past 12 months (<4 VOC hospitalizations) (n = 22); and (d) established with high utilization in past 12 months (≥4 VOC hospitalizations) (n = 10). Patient and hospitalization characteristics and future utilization were compared across categories. Results Median age was 26 years (Q1 = 22, Q3 = 29) and 55.6% were female. Established patients with high prior utilization tended to have higher median pain scores at admission (10, P = .08). Thirty‐day readmissions were highest in established patients with high prior utilization (P = .06), but 30‐day clinic visits were highest in established patients with low prior utilization (P = .08). Adjusted linear regression found that newly established patients (β = −4.6, P < .01) and established patients with low prior utilization (β = −5.6, P < .01) had fewer VOC hospitalizations in the ensuing 12 months than established patients with high prior utilization. Conclusion Among patients with SCD hospitalized for VOC, there was heterogeneity in healthcare utilization, with persistence in utilization over time for some patients. Efforts are needed to shift care from the acute setting to the outpatient clinic, which may lead to improved outcomes. |
| first_indexed | 2024-03-12T14:05:55Z |
| format | Article |
| id | doaj.art-9db76037ec4b46669538865c4e49894c |
| institution | Directory Open Access Journal |
| issn | 2688-6146 |
| language | English |
| last_indexed | 2024-03-12T14:05:55Z |
| publishDate | 2020-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | eJHaem |
| spelling | doaj.art-9db76037ec4b46669538865c4e49894c2023-08-21T14:10:56ZengWileyeJHaem2688-61462020-11-011243844710.1002/jha2.84Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crisesAngie Mae Rodday0Kimberly S Esham1Nicole Savidge2Susan K Parsons3Tufts Medical Center The Institute for Clinical Research and Health Policy Studies Boston Massachusetts USADepartment of Medicine Tufts University School of Medicine Boston Massachusetts USATufts Medical Center The Institute for Clinical Research and Health Policy Studies Boston Massachusetts USATufts Medical Center The Institute for Clinical Research and Health Policy Studies Boston Massachusetts USAAbstract Background Vaso‐occlusive crises (VOC) are the hallmark of sickle cell disease (SCD). Adults experiencing VOC often have high rates of unexpected healthcare utilization. We characterized prior and future healthcare utilization among adults hospitalized with VOC at an urban, academic medical center. Methods We identified 449 VOC hospitalizations among 63 patients from 2013 to 2016. Patients were categorized based on receiving established care at the medical center and prior utilization: (a) not established (n = 21); (b) newly established (n = 10); (c) established with low utilization in past 12 months (<4 VOC hospitalizations) (n = 22); and (d) established with high utilization in past 12 months (≥4 VOC hospitalizations) (n = 10). Patient and hospitalization characteristics and future utilization were compared across categories. Results Median age was 26 years (Q1 = 22, Q3 = 29) and 55.6% were female. Established patients with high prior utilization tended to have higher median pain scores at admission (10, P = .08). Thirty‐day readmissions were highest in established patients with high prior utilization (P = .06), but 30‐day clinic visits were highest in established patients with low prior utilization (P = .08). Adjusted linear regression found that newly established patients (β = −4.6, P < .01) and established patients with low prior utilization (β = −5.6, P < .01) had fewer VOC hospitalizations in the ensuing 12 months than established patients with high prior utilization. Conclusion Among patients with SCD hospitalized for VOC, there was heterogeneity in healthcare utilization, with persistence in utilization over time for some patients. Efforts are needed to shift care from the acute setting to the outpatient clinic, which may lead to improved outcomes.https://doi.org/10.1002/jha2.84clinical researchhealth services researchsickle cell disease |
| spellingShingle | Angie Mae Rodday Kimberly S Esham Nicole Savidge Susan K Parsons Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises eJHaem clinical research health services research sickle cell disease |
| title | Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises |
| title_full | Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises |
| title_fullStr | Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises |
| title_full_unstemmed | Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises |
| title_short | Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises |
| title_sort | patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises |
| topic | clinical research health services research sickle cell disease |
| url | https://doi.org/10.1002/jha2.84 |
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