Increased acute care utilization in a prospective cohort of adults with sickle cell disease

Lanzkron, Sophie; Little, Jane A.; Field, Joshua J.; Shows, Joseph Ryan; Wang, Hang; Seufert, Rebecca; Brooks, Jasmine; Varadhan, Ravi; Haywood, Carlton; Saheed, Mustapha; Huang, Chiung Yu; Griffin, Brandi; Frymark, Steven; Piehet, Allie; Robertson, D. M.; Proudford, Marc; Kincaid, Adrienne; Green, Charles; Burgess, Lorri; Wallace, Marcus; Segal, Jodi B

doi:10.1182/bloodadvances.2018018382

Cited by 35 publications

(37 citation statements)

References 17 publications

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“…Our study revealed high health service utilization and low rates of HU adherence, which are consistent with prior studies of SCD health care utilization. 16,25,[35][36][37][38] We also found, however, a strikingly low rate of comanagement between the PCP and SCD specialist, simply defined as 1 visit to both a PCP and hematologist. Furthermore, we noted high utilization of additional services by nonhematologist specialist and significant variations in HU adherence by age group.…”

Section: Discussionmentioning

confidence: 63%

“…This rate was lower than prior rates of up to 90% reported by Brousseau et al 4 In the Ͻ18-year-old group, our sample had a lower ED encounter rate (65.88%) compared with the national estimate of 67%. 38 In addition, previous studies have highlighted the highest EDR among the patients transitioning from pediatrics to adult medical care with an associated high health care cost. 39 Our sample also highlighted poor transition to adult medical care with a significant percentage of 18-to-30-year-old patients (44.69% of the sample) having greater than IQR, interquartile ranges *There were zero participants on HU in the 65ϩ age group so they were excluded from this analysis.…”

Section: Ed Encounters and Hospitalizationmentioning

confidence: 99%

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Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

et al. 2020

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Background: Sickle-cell disease (SCD) causes significant morbidity, premature mortality, and high disease burden, resulting in frequent health care use. Comanagement may improve utilization and patient adherence with treatments such as Hydroxyurea. The purpose of this study was to describe acute-care utilization in Medicaid-enrolled patients with SCD, patient factors associated with comanagement, and adherence to Hydroxyurea.Methods: Data from 2790 patients diagnosed with SCD, age 1 to 65؉ years, enrolled at least 1 month in North Carolina Medicaid between March 2016 and February 2017, were analyzed. Outpatient visits were categorized as primary care, hematologist, and nonhematologist specialist. Nurse practitioners or physician assistants with unidentified specialty type or family practice were categorized separately. Comanagement was defined as a minimum of 1 primary care and 1 hematologist visit/patient during the study period.Results: There were notable age-related differences in utilization of health care services. Only 34.82% of the sample was comanaged. Comanagement was higher in the 1-to-9-year-old (44.88%) and 10-to-17-year-old groups (39.22%) versus the 31-to-45-year-old (30.26%) and 65؉-year-old (18.75%) age groups. Age had the greatest influence (AUC ‫؍‬ 0.599) on whether or not a patient was comanaged. Only a third of the sample (32.24%) had at least 1 Hydroxyurea (HU) prescription. Age was the most predictive factor of good HUadherence (AUC ‫؍‬ 0.6503). Prediction by comanagement was minimal with an AUC ‫؍‬ 0.5615.Conclusion : Comanagement was a factor in predicting HUadherence, but further studies are needed to identify the frequency and components of comanagement needed to increase adherence and reduce acute care utilization. (J Am Board Fam Med 2020;33:91-105.)Sickle-cell disease (SCD) is a genetic disorder and the most common rare blood disease in the United States. 1 Patients suffer from complications, includ-ing but not limited to stroke, acute chest syndrome, and severe painful crisis that contributes to morbidity and premature mortality. Individuals also suffer from significant disease burden, often resulting in a high number of hospitalizations, readmissions, emergency department (ED) visits, and other associated costs to the health care system. In 2006 people with SCD had an estimated 232,382 ED visits, 68,410 hospitalizations from the ED, accounting for an estimated $2.4 billion dollars. 2 In 2010, SCD was associated with the highest 30-day readmission rate (31.9%) among all diagnoses excluding cancer and cancer-related conditions. 3 Other national data representing about 1 ⁄3 of the SCD population found a similar 30-day readmis-This article was externally peer reviewed.

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Section: Discussionmentioning

confidence: 63%

Section: Ed Encounters and Hospitalizationmentioning

confidence: 99%

Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

et al. 2020

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“…[5] Consistent predictors for increased HCU and costs in the literature have included older age, female gender, acute chest syndrome, stroke, red blood cell transfusions, public insurance, and the number of hospitalizations. [20][21][22][23][24][25][26] We found that the median cost of care for UIC adults with SCD in the year prior to referral for HSCT was $44,533 with an interquartile range of $16,151 -$126,473. Higher costs of care were associated with red blood cell transfusion requirements and inpatient hospital days.…”

Section: Discussionmentioning

confidence: 83%

Improved health care utilization and costs in transplanted versus non-transplanted adults with sickle cell disease

et al. 2020

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Patients with sickle cell disease (SCD) have access to fewer health care resources and therapies compared to other diseases, which contributes to increased morbidity and health care utilization. We compared health care utilization (inpatient hospital days, emergency care visits) and health care-related costs between SCD adults that underwent hematopoietic stem cell transplantation (HSCT) using a nonmyeloblative conditioning regimen versus those referred for HSCT but did not proceed due to lack of an HLA-matched sibling donor, denial by insurance, red blood cell antibodies to the potential donor, or declining further evaluation. Between 8/2011 and 4/2016, 83 SCD patients were referred for allogeneic HSCT and 16 underwent the procedure. The HSCT and non-HSCT groups were similar by age, sex, prior SCD-related therapy and complications. Compared to pre HSCT, significantly fewer inpatient hospital days (median of 1 versus 22 days, P = 0.003) and emergency care visits (median of 1 versus 4 visits, P = 0.04) were observed by the 2 nd year post-HSCT. Similar results were observed in comparison to the standard-of-care group (median of 1 versus 12 hospital days, P = 0.002; median of 1 versus 3 emergency visits, P = 0.03). Lower health care costs were observed by the 2 nd year post-HSCT

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“… 19 In addition, the oldest and youngest patients with frequent VOCs (≥2 unscheduled acute care visits) were classified as having more severe disease than patients 8–40 years old with a similar number of VOCs. Increasing age has been associated with risk of early death, 13 , 20 increased acute care visits, 21 and a higher severity score in Sebastiani et al’s network analysis model (that used a cohort of 3,380 individuals from the Cooperative Study of Sickle Cell Disease to predict the risk of death). 4 We also agreed that younger patients with frequent VOCs should be classified as more severe due to their increased risk for complications earlier in life.…”

Section: Discussionmentioning

confidence: 99%

<p>Development of a Severity Classification System for Sickle Cell Disease</p>

Shah¹,

Beenhouwer²,

Broder³

et al. 2020

CEOR

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Purpose There is no well-accepted classification system of overall sickle cell disease (SCD) severity. We sought to develop a system that could be tested as a clinical outcome predictor. Patients and Methods Using validated methodology (RAND/UCLA modified Delphi panel), 10 multi-disciplinary expert clinicians collaboratively developed 180 simplified patient histories and rated each on multiple axes (estimated clinician follow-up frequency, risk of complications or death, quality of life, overall disease severity). Using ratings on overall disease severity, we developed a 3-level severity classification system ranging from Class I (least severe) to Class III (most severe). Results The system defines patients as Class I who are 8–40 years with no end organ damage, no chronic pain, and ≤4 unscheduled acute care visits due to vaso-occlusive crises (VOC) in the last year. Patients <8 or >40 years with no end organ damage, no chronic pain, and <2 unscheduled acute care visits are also considered Class I. Patients any age with ≥5 unscheduled acute care visits and/or with severe damage to bone, retina, heart, lung, kidney, or brain are classified as Class III (except patients ≥25 years with severe retinopathy, no chronic pain, and 0–1 unscheduled acute care visits, who are considered Class II). Patients not meeting these Class I or III definitions are classified as Class II. Conclusion This system consolidates patient characteristics into homogenous groups with respect to disease state to support clinical decision-making. The system is consistent with existing literature that increased unscheduled acute care visits and organ damage translate into clinically significant patient morbidity. Studies to further validate this system are planned.

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Increased acute care utilization in a prospective cohort of adults with sickle cell disease

Cited by 35 publications

References 17 publications

Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

Improved health care utilization and costs in transplanted versus non-transplanted adults with sickle cell disease

<p>Development of a Severity Classification System for Sickle Cell Disease</p>

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