Risk Factors for 30-Day Readmission in Adults with Sickle Cell Disease

Brodsky, Max A.; Rodeghier, Mark; Sanger, Maureen; Byrd, Jeannie; McClain, Brandi; Covert, Brittany; Roberts, Dionna O.; Wilkerson, Karina; DeBaun, Michael R.; Kassim, Adetola A.

doi:10.1016/j.amjmed.2016.12.010

Cited by 32 publications

(43 citation statements)

References 29 publications

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“…40 A significant contributor to health care costs in the chronically ill is 30-day rehospitalization rates, which may reflect the lack of access and quality of ambulatory care for patients with SCD. 2,37,41,42 We found 7-, 14-, and 30-day rehospitalization rates were lower than prior findings (5% to 16%). 2,40 These lower rates may be due to state-based efforts by CCNC to reduce hospital admissions and readmissions, variations in access to care and insurance benefits by state and previous studies performing analysis on data over a decade ago.…”

Section: Ed Encounters and Hospitalizationcontrasting

confidence: 81%

“…Our study revealed high health service utilization and low rates of HU adherence, which are consistent with prior studies of SCD health care utilization. 16,25,[35][36][37][38] We also found, however, a strikingly low rate of comanagement between the PCP and SCD specialist, simply defined as 1 visit to both a PCP and hematologist. Furthermore, we noted high utilization of additional services by nonhematologist specialist and significant variations in HU adherence by age group.…”

Section: Discussionmentioning

confidence: 63%

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Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

et al. 2020

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Background: Sickle-cell disease (SCD) causes significant morbidity, premature mortality, and high disease burden, resulting in frequent health care use. Comanagement may improve utilization and patient adherence with treatments such as Hydroxyurea. The purpose of this study was to describe acute-care utilization in Medicaid-enrolled patients with SCD, patient factors associated with comanagement, and adherence to Hydroxyurea.Methods: Data from 2790 patients diagnosed with SCD, age 1 to 65؉ years, enrolled at least 1 month in North Carolina Medicaid between March 2016 and February 2017, were analyzed. Outpatient visits were categorized as primary care, hematologist, and nonhematologist specialist. Nurse practitioners or physician assistants with unidentified specialty type or family practice were categorized separately. Comanagement was defined as a minimum of 1 primary care and 1 hematologist visit/patient during the study period.Results: There were notable age-related differences in utilization of health care services. Only 34.82% of the sample was comanaged. Comanagement was higher in the 1-to-9-year-old (44.88%) and 10-to-17-year-old groups (39.22%) versus the 31-to-45-year-old (30.26%) and 65؉-year-old (18.75%) age groups. Age had the greatest influence (AUC ‫؍‬ 0.599) on whether or not a patient was comanaged. Only a third of the sample (32.24%) had at least 1 Hydroxyurea (HU) prescription. Age was the most predictive factor of good HUadherence (AUC ‫؍‬ 0.6503). Prediction by comanagement was minimal with an AUC ‫؍‬ 0.5615.Conclusion : Comanagement was a factor in predicting HUadherence, but further studies are needed to identify the frequency and components of comanagement needed to increase adherence and reduce acute care utilization. (J Am Board Fam Med 2020;33:91-105.)Sickle-cell disease (SCD) is a genetic disorder and the most common rare blood disease in the United States. 1 Patients suffer from complications, includ-ing but not limited to stroke, acute chest syndrome, and severe painful crisis that contributes to morbidity and premature mortality. Individuals also suffer from significant disease burden, often resulting in a high number of hospitalizations, readmissions, emergency department (ED) visits, and other associated costs to the health care system. In 2006 people with SCD had an estimated 232,382 ED visits, 68,410 hospitalizations from the ED, accounting for an estimated $2.4 billion dollars. 2 In 2010, SCD was associated with the highest 30-day readmission rate (31.9%) among all diagnoses excluding cancer and cancer-related conditions. 3 Other national data representing about 1 ⁄3 of the SCD population found a similar 30-day readmis-This article was externally peer reviewed.

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Section: Ed Encounters and Hospitalizationcontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 63%

Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

et al. 2020

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“…1 Risk factors, such as prescribing nonsteroidal anti-inflammatory drugs without opioids, older age, and steroid treatment, are associated with readmissions in pediatric SCD patients, 2,3 but limited data exist in adults. 4,5 Premature discharge based on pain scores, absence of primary care providers and multiple VOC-related admissions in the prior year are associated with increased risk of 30-day readmission (30-DR) in adult SCD patients. 4,5 In this report, we analyzed the inpatient and outpatient opioid utilization in a cohort of 70 adult SCD patients hospitalized for an uncomplicated VOC, and found that a high opioid dose during the last 24-hours of the inpatient stay compared with the home dose after discharge is a modifiable risk factor for readmission.…”

Section: Supporting Informationmentioning

confidence: 99%

“…4,5 Premature discharge based on pain scores, absence of primary care providers and multiple VOC-related admissions in the prior year are associated with increased risk of 30-day readmission (30-DR) in adult SCD patients. 4,5 In this report, we analyzed the inpatient and outpatient opioid utilization in a cohort of 70 adult SCD patients hospitalized for an uncomplicated VOC, and found that a high opioid dose during the last 24-hours of the inpatient stay compared with the home dose after discharge is a modifiable risk factor for readmission. Pain score before discharge 5 (4-6) 5.5 (4)(5)(6) .934 5 (4-7) 5 (4-7)…”

Section: Supporting Informationmentioning

confidence: 99%

“…4,5 In this report, we analyzed the inpatient and outpatient opioid utilization in a cohort of 70 adult SCD patients hospitalized for an uncomplicated VOC, and found that a high opioid dose during the last 24-hours of the inpatient stay compared with the home dose after discharge is a modifiable risk factor for readmission. Pain score before discharge 5 (4-6) 5.5 (4)(5)(6) .934 5 (4-7) 5 (4-7)…”

Section: Supporting Informationmentioning

confidence: 99%

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High inpatient dose of opioid at discharge compared to home dose predicts readmission risk in sickle cell disease

et al. 2018

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Cerebral oxygen metabolism in adults with sickle cell disease

et al. 2020

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In sickle cell disease (SCD), oxygen delivery is impaired due to anemia, especially during times of increased metabolic demand, and cerebral blood flow (CBF) must increase to meet changing physiologic needs. But hyperemia limits cerebrovascular reserve (CVR) and ischemic risk prevails despite elevated CBF. The cerebral metabolic rate of oxygen (CMRO2) directly reflects oxygen supply and consumption and may therefore be more insightful than flow‐based CVR measures for ischemic risk in SCD. We hypothesized that adults with SCD have impaired CMRO2 at rest and that a vasodilatory challenge with acetazolamide would improve CMRO2. CMRO2 was calculated from CBF and oxygen extraction fraction (OEF), measured with arterial spin labeling and T2‐prepared tissue relaxation with inversion recovery (T2‐TRIR) MRI. We studied 36 adults with SCD without a clinical history of overt stroke, and nine healthy controls. As expected, CBF was higher in patients with SCD versus controls (mean ± SD: 74 ± 16 versus 46 ± 5 mL/100 g/min, P < .001), resulting in similar oxygen delivery (SCD: 377 ± 67 versus controls: 368 ± 42 μmol O2/100g/min, P = .69). OEF was lower in patients versus controls (27 ± 4 versus 35 ± 4%, P < .001), resulting in lower CMRO2 in patients versus controls (102 ± 24 versus 127 ± 20 μmol O2/100g/min, P = .002). After acetazolamide, CMRO2 declined further in patients (P < .01) and did not decline significantly in controls (P = .78), indicating that forcing higher CBF worsened oxygen utilization in SCD patients. This lower CMRO2 could reflect variation between healthy and unhealthy vascular beds in terms of dilatory capacity and resistance whereby dysfunctional vessels become more oxygen‐deprived, hence increasing the risk of localized ischemia.

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Risk Factors for 30-Day Readmission in Adults with Sickle Cell Disease

Cited by 32 publications

References 29 publications

Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

High inpatient dose of opioid at discharge compared to home dose predicts readmission risk in sickle cell disease

Cerebral oxygen metabolism in adults with sickle cell disease

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