Faculty Collaboration Database

Intensive management of high-utilizing adults with sickle cell disease lowers admissions. Am J Hematol 2015 Mar;90(3):215-9

Date

12/04/2014

Pubmed ID

25469750

DOI

10.1002/ajh.23912

Scopus ID

2-s2.0-84923103908 (requires institutional sign-in at Scopus site)   26 Citations

Abstract

A minority of super-utilizing adults with sickle cell disease (SCD) account for a disproportionate number of emergency department (ED) and hospital admissions. We performed a retrospective cohort study comparing the rate of admission before and after the opening of a clinic for adults with SCD. Unique to this clinic was an intensive management strategy, focusing on super-utilizing adults with 12 or more admissions per year. ED/hospital and 30 days re-admission rates were compared, 1 year pre- and post-intervention, for those adults who established in the clinic. Prior to the intervention, 17 super-utilizers, comprising 15% of the pre-intervention cohort (n = 115), accounted for 58% of the total admissions and had an admission rate of 28 per patient-year. When pre- and post-intervention years were compared, rate of ED/hospital admission per patient-year for super-utilizers decreased from 27.9 to 13.5 (P < 0.001), while there was not a significant reduction for the entire cohort (7.1 vs. 6.1, P = 0.84). Similarly, the decrease in rate of 30 day re-admission was larger for the super-utilizers (13.5 per patient-year to 1.8, P < 0.001), than the whole cohort (2.6 per patient-year to 0.7, P = 0.006). Among the super-utilizers, the reduced rate of admission from the pre- to post-clinic intervention year equated to 252 fewer ED/hospital admissions and 227 fewer 30 day re-admissions. This management strategy focusing on super-utilizing adults with SCD lowered admission and 30 day re-admission rate.

Author List

Koch KL, Karafin MS, Simpson P, Field JJ

Authors

Joshua J. Field MD Professor in the Medicine department at Medical College of Wisconsin
Kathryn L. Koch NP APP Hybrid in the Medicine department at Medical College of Wisconsin
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

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

Adolescent
Adult
Analgesics
Anemia, Sickle Cell
Antisickling Agents
Blood Transfusion
Disease Management
Emergency Service, Hospital
Female
Health Services Misuse
Hospitalization
Humans
Hydroxyurea
Male
Retrospective Studies