Four of every 10 individuals with sickle cell disease had to return to the hospital within 30 days of a previous hospitalization or go to the emergency department for treatment of pain, according to the largest study to date on use of acute care medical services by these patients. The study was conducted by David C. Brousseau, M.D., M.S., and colleagues at the Medical College of Wisconsin and the Children's Hospital of Wisconsin.
Sickle cell disease, an inherited blood disorder, most commonly causes acute, severe, recurrent painful episodes due to occlusion of blood vessels by sickle-shaped 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 an estimated 70,000 to 100,000 persons in the United States, with blacks disproportionately affected.
When the researchers analyzed acute care use by age groups, they found that 18- to 30-year-old patients had the highest rate of rehospitalizations within 30 days (41 percent). Two-thirds of these patients were actually readmitted within 14 days of their previous hospital discharge. This group was also more likely to go to the emergency department for treatment of pain and then be released (20 percent within 30 days). In general, they had approximately three and a half hospital visits per year—either a rehospitalization or an emergency department visit—regardless of their insurance. This rate is markedly higher than the two visits per year for children 10 to 17 years old with sickle cell disease.
Regardless of age, the patients with Medicaid or other types 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 of medical use—nearly five encounters per year compared with all other age groups with any other insurance, private or public.
The study was based on 21,112 patients with sickle cell disease 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.
More details are in "Acute care utilization and rehospitalizations for sickle cell disease," by Dr. Brousseau, Pamela L. Owens, Ph.D., Andrew L. Mosso, M.S., and others, in the April 7, 2010, issue of the Journal of the American Medical Association 303(13), pp. 1288-1294.