A Multidisciplinary Care Management Program for Patients with Sickle Cell Syndromes Significantly Reduces Health Care Resource Utilization.

Abstract

The Georgia Comprehensive Sickle Cell Center at Grady Memorial Hospital was established in 1985 to provide primary care and 24 hour acute care to patients with sickle cell syndromes with the goals of providing better patient care. The Center is equipped with an acute care center with 12 observation beds, a clinic area with 6 exam rooms, a waiting room, a multimedia teaching center for patients, and support offices. The initial experience showed very high outpatient and inpatient utilization by a small number of patients. In 1990, to address this problem, a comprehensive care program was instituted. The multidisciplinary care management program involving physicians, nurses, physician assistants, nurse practitioners, clinic assistants, social workers, psychologists, secretarial support and a psychiatric clinical nurse specialist addresses patients’ medical, social, psychological and vocational needs. Outcome analysis of the impact of this program is based on demographics, disease-specific characteristics, outpatient visit frequency, and admission data contained in a clinical database. This analysis shows that the program significantly reduced acute care visits and hospital admissions. In the five year period from 1985–1989, prior to the multidisciplinary program, there were 1152 acute care visits per 100 patients/year and 137 admissions per 100 patients/year. In the five year period following institution of the multidisciplinary management program, acute care visits were reduced to 355 acute care visits per 100 patients/year and 61 hospital admissions per 100 patients/year. These results were durable for the next decade (Table 1). Major factors in this reduction were departure of 24 patients with greater than 52 visits a year and a similar reduction in acute visits and hospitalizations in 166 patients that continued as active patients. A care facility dedicated to acute and ongoing management of patients with sickle cell syndromes is necessary, but not sufficient to improve their health outcomes. A multidisciplinary care program that addresses the medical, social and psychological needs of these patients is required to reduce health care utilization. In conclusion, this data demonstrates a dramatic decrease in hospital health resource utilization with the establishment of a multidisciplinary care management approach in a disease-specific comprehensive center. This model is effective for sickle cell syndromes; a chronic disease characterized by acute exacerbations, and could be considered in other similar diseases such as asthma, diabetes, and chest pain. Table 1. Georgia Comprehensive Sickle Cell Center - Clinical Activity 1985–1989 1990–1994 1995–1999 2000–2004 *Active patient = one or more visits every two years. **Mean ± SD Average active adult Pt/year* 414 ± 52** 545 ± 85 648 ± 125 1055 ± 113 Average F/U clinic appts/year 1362 ± 26 1879 ± 58 2128 ± 134 3190 ± 313 Acute care visits 100 Pt/years 1152 ± 129 355 ± 92 371 ± 36 348 ± 64 Admissions/100 Pt years 137 ± 19 61 ± 15 72 ± 11 53 ± 6