Four of every 10 people treated in a hospital for pain or other problems caused by sickle cell disease have to be readmitted for treatment again within 30 days, according to a new study published in the April 7 issue of JAMA. The study, the largest to date on the subject, also found that many sickle cell patients need emergency room care within 30 days of being discharged from a hospital.
The study was conducted by researchers at the Medical College of Wisconsin; Children's Research Institute at Children's Hospital of Wisconsin, both in Milwaukee; and the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) .
Sickle cell disease, an inherited blood disorder, most commonly causes acute, severe, recurrent painful episodes due to blockage of blood vessels by sickled red blood cells. People with sickle cell disease are also at increased risk for stroke and chronic problems, such as kidney and lung disease. The disease affects millions of people worldwide, including approximately 90,000 people in the United States. African Americans are disproportionately affected.
High rates of rehospitalization within 30 days of a previous hospital stay, an indicator of poor-quality post hospital outpatient care for a number of diseases, has only recently gained interest related to sickle cell care. The study showed high rates of rehospitalizations at 30 days, and also at 14 days, which may be a more accepted marker of care quality in sickle cell disease.
"It was important for us to draw attention to the high rate of acute care utilization for people with sickle cell disease. Armed with this knowledge we can focus attention on the need for improved care for those with sickle cell disease" said lead author David C. Brousseau, M.D., M.S., associate professor of pediatrics (section of emergency medicine) at the Medical College of Wisconsin. He also practices at Children's Hospital of Wisconsin as a pediatric emergency specialist.
"This study is important because it provides benchmark data to evaluate the quality of outpatient management of sickle cell disease symptoms," said AHRQ's Director Carolyn M. Clancy, M.D.
The study found that one in three sickle cell disease patients was rehospitalized within 30 days, a rate roughly 1.5 times greater than that of diabetes patients, twice that of heart failure patients, and nearly 10 times greater than the rate for pediatric asthma patients. Moreover, two-thirds of the patients rehospitalized within 30 days were re-admitted within 14 days of their previous hospital discharge, suggesting that interventions to prevent rehospitalizations need to happen during or soon after the hospitalization.
When the researchers analyzed acute care use by age, they found that 18- to- 30 year-olds had over three and a half acute care encounters -- rehospitalizations or treat-and release emergency department visits--per year, a rate markedly higher than the two visits per year from children 10-17 years old. Regardless of age, the patients with Medicaid or other type of public insurance used acute care for sickle cell related reasons more than privately insured and uninsured patients. Publicly insured 18-to-30 year-old patients had the highest rate -- nearly five encounters per year.
This same age group also had the highest rate of hospital readmissions within 30 days or 14 days of their previous hospitalization, 41 percent and 28 percent respectively, and the highest rate of emergency department visits within the same time frame, 20 percent and 14 percent respectively.
The study was based on 21,112 sickle cell disease patients in eight states -- Arizona, California, Florida, Massachusetts, Missouri, New York, South Carolina and Tennessee -- who were hospitalized or treated and released from hospital emergency departments in 2005 and 2006. The state databases are part of the AHRQ-administered Healthcare Cost and Utilization Project.
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