Acute Care Utilization and Rehospitalizations for Sickle Cell Disease

TLDR

The study aimed to provide benchmark data for rates of acute care utilization and rehospitalizations among patients with sickle cell disease. A retrospective cohort analysis of 21,112 SCD patients’ emergency department visits and hospitalizations was conducted using 2005‑2006 HCUP State Inpatient and Emergency Department Databases from eight geographically diverse states representing 33% of the US SCD population. In this cohort, the mean annual acute care encounter rate was 2.59 per patient, with 1.52 hospitalizations and 1.08 treat‑and‑release ED visits, 30‑day rehospitalization occurred in 33.4% of patients—rates highest among 18‑to‑30‑year‑olds and publicly insured individuals—while 29% had no encounters and 16.9% had three or more per year.

Abstract

<h3>Context</h3>Published rates of health care utilization and rehospitalization by people with sickle cell disease have had limited generalizability and are not population based.<h3>Objective</h3>To provide benchmark data for rates of acute care utilization and rehospitalizations for patients with sickle cell disease.<h3>Design</h3>Retrospective cohort of sickle cell disease–related emergency department (ED) visits and hospitalizations from select states in the 2005 and 2006 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and State Emergency Department Databases.<h3>Setting</h3>Eight geographically dispersed states (Arizona, California, Florida, Massachusetts, Missouri, New York, South Carolina, and Tennessee) that provide encrypted identifiers and have sufficient numbers of patients with sickle cell disease; together these states have 33% of the US population with sickle cell disease.<h3>Patients</h3>A total of 21 112 patients with sickle cell–related treat-and-release ED visits or inpatient hospitalizations.<h3>Main Outcome Measures</h3>Rates of acute care utilization and rehospitalizations. Population-based utilization rates were also calculated.<h3>Results</h3>The 21 112 people with sickle cell disease had 109 344 encounters, a mean of 2.59 (95% confidence interval [CI], 2.53-2.65) encounters per patient per year, 1.52 (95% CI, 1.48-1.55) encounters for hospitalizations and 1.08 (95% CI, 1.04-1.11) for treat-and-release ED visits. Utilization was highest for 18- to 30-year-olds, 3.61 (95% CI, 3.47-3.75) encounters per patient per year, and those with public insurance, 3.22 (95% CI, 3.13-3.31) encounters per patient per year. Publicly insured 18- to 30-year-olds had 4.80 (95% CI, 4.58-5.02) encounters per patient per year. Approximately 29% of the population had no encounters while 16.9% had 3 or more encounters per year. The 30-day and 14-day rehospitalization rates were 33.4% (95% CI, 33.0%-33.8%) and 22.1% (95% CI, 21.8%-22.4%), respectively. The rehospitalization rate was highest for 18- to 30-year-olds, with 41.1% (95% CI, 40.5%-41.7%) rehospitalized within 30 days and 28.4% (95% CI, 27.8%-29.0%) within 14 days. Rehospitalizations were also highest for publicly insured patients.<h3>Conclusion</h3>Among patients with sickle cell disease, acute care encounters and rehospitalizations were frequent, particularly for 18- to 30-year-olds.