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Concentration of hospital care for acute sickle cell disease-related visits. Pediatr Blood Cancer 2012 Oct;59(4):685-9 PMID: 22180290 PMCID: PMC3310931

Pubmed ID

22180290

DOI

10.1002/pbc.24028

Abstract

BACKGROUND: Sickle cell disease (SCD) is characterized by frequent disease-related events that require acute care. It is unknown to what extent patients utilize multiple hospitals for acute care. We examined the continuity pattern of acute care visits to the hospital or emergency department. We hypothesized that among patients with multiple SCD related acute care visits, children experience more concentrated hospital care than adults and privately insured patients experience more concentrated hospital care than publicly insured patients.

PROCEDURE: We conducted a retrospective cohort study using data from the 2005 and 2006 Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases. Subjects included patients with SCD ≥ 1 year of age. The primary outcome was proportion of patients with multiple acute care visits to a single hospital.

RESULTS: A total of 13,533 patients made ≥ 2 acute SCD-related visits. Of the 5,030 children, 77.3% went to the same hospital for all visits. In contrast, of the 8,503 adults, only 51.3% visited the same hospital. Adolescents were more likely than adults to go to one hospital [adjusted relative risk (ARR) 1.40, confidence interval (CI) 1.35-1.45]. Those with public insurance and the uninsured had a decreased probability of using one hospital (ARR 0.96, CI 0.94-0.99, and ARR 0.83, CI 0.79-0.88, respectively).

CONCLUSIONS: Adults and patients with public insurance or no insurance are more likely to use multiple hospitals for acute care. By receiving acute care at multiple hospitals, patients with SCD experience dispersed and fragmented care potentially leading to decreased care quality.

Author List

Panepinto JA, Owens PL, Mosso AL, Steiner CA, Brousseau DC

Authors

David Brousseau MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Julie A. Panepinto MD, MSPH Professor in the Pediatrics department at Medical College of Wisconsin




Scopus

2-s2.0-84864932537   11 Citations

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adolescent
Adult
Age Factors
Anemia, Sickle Cell
Child
Child, Preschool
Continuity of Patient Care
Emergency Service, Hospital
Female
Hospitals
Humans
Infant
Male
Medicaid
Medically Uninsured
United States
Young Adult
jenkins-FCD Prod-321 98992d628744e349846c2f62ac68f241d7e1ea70