TY - JOUR
T1 - Age-Related Emergency Department Reliance in Patients with Sickle Cell Disease
AU - Blinder, Morey A.
AU - Duh, Mei Sheng
AU - Sasane, Medha
AU - Trahey, Alex
AU - Paley, Carole
AU - Vekeman, Francis
N1 - Funding Information:
This study was funded by Novartis Pharmaceuticals Corporation . Francis Vekeman, Alex Trahey, and Mei Sheng Duh are employees of Analysis Group, Inc., which has received research grants from Novartis Pharmaceuticals Corporation . Morey A. Blinder is a paid consultant to Novartis Pharmaceuticals Corporation. M Sasane and C Paley are employees of Novartis Pharmaceuticals Corporation. The authors affirm that they have listed everyone who contributed to the development of this manuscript.
Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/10
Y1 - 2015/10
N2 - Background Emergency Department Reliance (EDR: total emergency department [ED] visits/total ambulatory [outpatient + ED] visits) differentiates acute episodic ED users from those who may not have adequate access to outpatient care. Objective This study's aim was to investigate age-related patterns of EDR and associated health-care costs in pediatric patients with sickle cell disease (SCD) and those transitioning from pediatric to adult care. Methods State Medicaid data were used for this study. Patients with two or more SCD diagnoses and one or more blood transfusion were included. Quarterly rates of ED visits, EDR, SCD complications associated with ED visits, and ED visits resulting in hospitalization were evaluated. Risk factors associated with high EDR and the association between high EDR and health-care costs were explored through regression analyses. Results A total of 3208 patients were included. The most common SCD complications associated with ED visits were pain, infection, and pneumonia. Beginning at the age of 15 years, EDR rose from 0.17 to 0.29 visits per quarter at age 22 years, and remained high throughout adulthood. Regression analyses indicated that patients were most likely to have high EDR during the post-transition period and when experiencing an SCD complication. Patients with high EDR incurred statistically significantly higher inpatient and ED costs, resulting in significantly higher total health-care costs. Conclusions Compared to children, patients transitioning to adulthood relied more on the ED for their care. In addition, patients with high EDR incurred more days in the hospital and significantly higher health-care costs, highlighting the need to improve transition-related support, including better access to primary care and increased engagement with patients with SCD.
AB - Background Emergency Department Reliance (EDR: total emergency department [ED] visits/total ambulatory [outpatient + ED] visits) differentiates acute episodic ED users from those who may not have adequate access to outpatient care. Objective This study's aim was to investigate age-related patterns of EDR and associated health-care costs in pediatric patients with sickle cell disease (SCD) and those transitioning from pediatric to adult care. Methods State Medicaid data were used for this study. Patients with two or more SCD diagnoses and one or more blood transfusion were included. Quarterly rates of ED visits, EDR, SCD complications associated with ED visits, and ED visits resulting in hospitalization were evaluated. Risk factors associated with high EDR and the association between high EDR and health-care costs were explored through regression analyses. Results A total of 3208 patients were included. The most common SCD complications associated with ED visits were pain, infection, and pneumonia. Beginning at the age of 15 years, EDR rose from 0.17 to 0.29 visits per quarter at age 22 years, and remained high throughout adulthood. Regression analyses indicated that patients were most likely to have high EDR during the post-transition period and when experiencing an SCD complication. Patients with high EDR incurred statistically significantly higher inpatient and ED costs, resulting in significantly higher total health-care costs. Conclusions Compared to children, patients transitioning to adulthood relied more on the ED for their care. In addition, patients with high EDR incurred more days in the hospital and significantly higher health-care costs, highlighting the need to improve transition-related support, including better access to primary care and increased engagement with patients with SCD.
KW - access to care
KW - acute care
KW - emergency department
KW - emergency department reliance
KW - health-care costs
KW - sickle cell disease
KW - transfusion
UR - http://www.scopus.com/inward/record.url?scp=84943580591&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2014.12.080
DO - 10.1016/j.jemermed.2014.12.080
M3 - Article
C2 - 25910824
AN - SCOPUS:84943580591
SN - 0736-4679
VL - 49
SP - 513-522.e1
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 4
ER -