Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises

Abstract

Background Vaso‐occlusive crises (VOC) are the hallmark of sickle cell disease (SCD). Adults experiencing VOC often have high rates of unexpected healthcare utilization. We characterized prior and future healthcare utilization among adults hospitalized with VOC at an urban, academic medical center. Methods We identified 449 VOC hospitalizations among 63 patients from 2013 to 2016. Patients were categorized based on receiving established care at the medical center and prior utilization: (a) not established (n = 21); (b) newly established (n = 10); (c) established with low utilization in past 12 months (<4 VOC hospitalizations) (n = 22); and (d) established with high utilization in past 12 months (≥4 VOC hospitalizations) (n = 10). Patient and hospitalization characteristics and future utilization were compared across categories. Results Median age was 26 years (Q1 = 22, Q3 = 29) and 55.6% were female. Established patients with high prior utilization tended to have higher median pain scores at admission (10, P = .08). Thirty‐day readmissions were highest in established patients with high prior utilization (P = .06), but 30‐day clinic visits were highest in established patients with low prior utilization (P = .08). Adjusted linear regression found that newly established patients (β = −4.6, P < .01) and established patients with low prior utilization (β = −5.6, P < .01) had fewer VOC hospitalizations in the ensuing 12 months than established patients with high prior utilization. Conclusion Among patients with SCD hospitalized for VOC, there was heterogeneity in healthcare utilization, with persistence in utilization over time for some patients. Efforts are needed to shift care from the acute setting to the outpatient clinic, which may lead to improved outcomes.

Evidence of protective effects of recombinant ADAMTS13 in a humanized model of sickle cell disease

“…36,46,47 In SCD, renal vasculopathy has been linked to both ischemic/reperfusion damage, resulting in vascular dysfunction and pro-fibrotic stimuli. 1,33 Here, we found that treatment with rADAMTS13 reduced atrophic tubules, glomerular inflammatory cell infiltration and decreased thrombi formation in SS mice compared with vehicle-treated SS animals (Figure 3A, Table 1). This was associated with significant reductions in both creatinine and blood urea nitrogen in rADAMTS13-treated SS mice exposed to H/R compared with their levels in vehicletreated animals (Figure 3B).…”

“…These main causes of hospitalization of SCD patients contribute to the disease’s high mortality and morbidity. 1-3 …”

“…These main causes of hospitalization of SCD patients contribute to the disease's high mortality and morbidity. [1][2][3] In the last decade, progress in the knowledge of the pathophysiology of SCD has highlighted the role of pro-adhesive cell-cell interactions involving dense red blood cells, reticulocytes, neutrophils, inflammatory activated endothelial cells, and plasma factors. [4][5][6][7][8][9] Collectively these factors contribute to the pro-thrombotic profile of SCD as supported by thrombin generation, depleted anticoagulant proteins, an activated fibrinolytic system, and in-creased tissue factor expression, even in steady state.…”

Homozygous Sickle Cell Disease after Age of 40: Follow‐Up of a Cohort of 209 Patients in Senegal, West Africa

“…Te introduction of hydroxyurea in SCD treatment is still limited in Africa [15,19]. In the multicenter study of SCD in sub-Saharan Africa, the same proportion was observed [20], which difers from developed countries, where proportions of around 64.5% of patients on hydroxyurea are reported [21]. Tis can be explained by many adverse efects of hydroxyurea, but also and above all by the unavailability and accessibility of the drug, given its high cost, beyond the reach of patients in Africa.…”

Descriptive epidemiology of sickle cell disease in Tennessee: population-based estimates from 2008 to 2019

“…These findings are consistent with prior research related to acute care utilization in SCD patients using data from 2005-2006 in Arizona, California, Florida, Massachusetts, Missouri, New York, South Carolina, and Tennessee which found that over 30% of the patients with healthcare encounters related to SCD were age 18-30 years old and that rates of ED visits and inpatient stays per year were highest in the 18-30 year old age group (ED = 1.59 (95% CI: 1.50-1.68) and admissions = 2.02 (1.94-2.10)) followed by the 31-45 year old age group (ED = 1.29 (1.20-1.38) and admissions = 1.65 (1.55-1.75)) (30). Additionally, a recent 3-year study of 449 hospitalizations among 63 patients that investigated vaso-occlusive pain in SCD found that the median age at first hospitalization in the study window was 26 years (interquartile range: 22, 29) (31). Acute healthcare utilization is drastically higher for those with SCD than for the general public.…”