Outpatient follow-up and rehospitalizations for sickle cell disease patients. Pediatr Blood Cancer 2012 Mar;58(3):406-9
Date
04/16/2011Pubmed ID
21495162DOI
10.1002/pbc.23140Scopus ID
2-s2.0-84855792696 (requires institutional sign-in at Scopus site) 56 CitationsAbstract
BACKGROUND: Rehospitalization rates are increasingly used as quality indicators for a variety of illnesses, including sickle cell disease. While one small, single center study suggested outpatient follow-up with a pediatric hematologist was associated with fewer rehospitalizations, no study has examined the effect of post-discharge outpatient follow-up on rehospitalization rates across ages and beyond a single site.
PROCEDURE: This is a retrospective cohort study using Wisconsin Medicaid claims data for hospitalized children and adults with sickle cell disease from 2003 to 2007. The primary outcomes were rehospitalization at both 14 and 30 days after an index hospitalization for sickle cell pain crisis (ICD-9-CM codes 28242, 28262, 28264, 28269). Univariate survival analyses were performed based on outpatient visit, severe disease, asthma, and age. The Cox proportional hazards model was used for multivariate analyses yielding hazard ratios for the association between outpatient visits and subsequent rehospitalization rates.
RESULTS: Of the 408 patients included, 42 (10.2%) patients were rehospitalized within 14 days and 70 (17.1%) were rehospitalized within 30 days. Multivariate analysis showed that an outpatient visit is associated with lower rates of both 30-day rehospitalization (Hazard Ratio (HR) 0.442; 95%CI: 0.330-0.593) and 14-day rehospitalization (HR 0.226; 95%CI: 0.124-0.412), with the majority of 30-day rehospitalizations occurring within 14 days.
CONCLUSIONS: For sickle cell disease, post-discharge planning should emphasize early follow-up to prevent subsequent hospitalization and improve care quality. Pediatr Blood Cancer 2012; 58: 406-409. © 2011 Wiley Periodicals, Inc.
Author List
Leschke J, Panepinto JA, Nimmer M, Hoffmann RG, Yan K, Brousseau DCAuthor
Ke Yan PhD, MS Associate Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Anemia, Sickle Cell
Benchmarking
Child
Child, Preschool
Continuity of Patient Care
Emergencies
Humans
Infant
Infant, Newborn
Medicaid
Middle Aged
Multivariate Analysis
Patient Discharge
Patient Readmission
Proportional Hazards Models
Retrospective Studies
United States
Wisconsin
