Outpatient Pain Predicts Subsequent One-Year Acute Health Care Utilization Among Adults With Sickle Cell Disease

Abstract

Context Patient demographic and clinical factors have known associations with acute health care utilization (AHCU) among patients with sickle cell disease (SCD), but it is unknown if pain measured predominantly in an outpatient setting is a predictor of future AHCU in patients with SCD. Objectives To determine whether multidimensional pain scores obtained predominantly in an outpatient setting predicted subsequent one-year AHCU by 137 adults with SCD and whether the pain measured at a second visit also predicted AHCU. Methods Pain data included the Composite Pain Index (CPI), a single score representative of a multidimensional pain experience (number of pain sites, intensity, quality, and pattern). Based on the distribution of AHCU events, we divided patients into three groups: (1) zero events (Zero), (2) 1–3 events (Low), or (3) 4–23 events (High). Results The initial CPI scores differed significantly by the three groups (F(2,134)=7.38, P=0.001). Post hoc comparisons showed that the Zero group had lower CPI scores than both the Low group (P<0.01) and the High group (P<0.001). In multiviariate, overdispersed Poisson regression analyses, age, and CPI scores (at both measurement times) were statistically significant predictors of utilization events. Pain intensity scores at both measurement times were significant predictors of utilization, but other pain scores (number of pain sites, quality, and pattern) were not. Conclusion Findings support use of outpatient CPI scores or pain intensity and age to identify at-risk young adults with SCD who are likely to benefit from improved outpatient pain management plans.

IL1A rs1800587 Associates with Chronic Noncrisis Pain in Sickle Cell Disease

“…There was no statistical association between utilization and rs1800587 in additive, dominant or recessive models (incident rate ratio Table 4) [26]. These findings suggested that IL1A rs1800587 influenced baseline, but not acute, pain in SCD.…”

“…Number of utilization ranged from 0 to 38 within 1 year. Three groups are created from utilization rates: 0 utilization (15% of total patients), 1-3 (45%) and 4-38 (40%) based on previous studies where the distribution of acute healthcare utilization events were taken into account 4 [26].…”

“…In other words, the utilization variances that are found within each genotype group are higher than the mean utilization of that same genotype group. SNP effects on utilization groups (three groups: zero events, 1-3 events and 4-38 events) were also analyzed by an ordinal logistic regression model adjusted for covariates [26]. Analyses were performed on SPSS software (version 22; IBM, NY, USA).…”

“…A computerized multidimensional pain assessment tool, PAINReportIt ® [2,26,27] (Nursing Consult, LLC, WA, USA), was used for pain phenotyping. Subjects completed baseline pain location, intensity, quality and pattern during a routine clinic visit (i.e., not during pain crisis or other urgent care visits to the clinic).…”

Dopamine D3 Receptor Ser9Gly and Catechol-O-Methyltransferase Val158Met Polymorphisms and Acute Pain in Sickle Cell Disease

“…Subjects completed a multidimensional computerized pain assessment using PAINReportIt ®2,16 to record baseline pain location, intensity, quality, and pattern during a routine outpatient clinic visit. PAINReportIt® is an electronic touch screen format of the 1970 version of MPQ (McGill Pain Questionnaire) 17 that can be self-administered by the patient with little or no computer experience.…”