Risk factors for hospitalizations and readmissions among individuals with sickle cell disease: results of a U.S. survey study

Abstract

Objective: Hospital admissions are significant events in the care of individuals with sickle cell disease (SCD) due to associated costs and potential for quality of life compromise. Methods: This cross-sectional cohort study evaluated risk factors for admissions and readmissions between October 2014 and March 2016 in adults with SCD (n = 201) and caregivers of children with SCD (n = 330) at six centres across the U.S. Survey items assessed social determinants of health (e.g. educational attainment, difficulty paying bills), depressive symptoms, social support, health literacy, spirituality, missed clinic appointments, and outcomes hospital admissions and 30-day readmissions in the previous year. Results: A majority of adults (64%) and almost half of children (reported by caregivers: 43%) were admitted, and fewer readmitted (adults: 28%; children: 9%). The most common reason for hospitalization was uncontrolled pain (admission: adults: 84%, children: 69%; readmissions: adults: 83%, children: 69%). Children were less likely to have admissions/readmissions than adults (Admissions: OR: 0.35, 95% CI: [0.23,0.52]); Readmissions: 0.23 [0.13,0.41]). For all participants, missing appointments were associated with admissions (1.66 [1.07, 2.58]) and readmissions (2.68 [1.28, 6.29]), as were depressive symptoms (admissions: 1.36 [1.16,1.59]; readmissions: 1.24 [1.04, 1.49]). In adults, difficulty paying bills was associated with more admissions, (3.11 [1.47,6.62]) readmissions (3.7 [1.76,7.79]), and higher spirituality was associated with fewer readmissions (0.39 [0.18,0.81]). Discussion: Missing appointments was significantly associated with admissions and readmissions. Findings confirm that age, mental health, financial insecurity, spirituality, and clinic attendance are all modifiable factors that are associated with admissions and readmissions; addressing them could reduce hospitalizations.

Household material hardships impact emergency department reliance in pediatric patients with sickle cell disease

“…These findings are consistent with studies in other pediatric populations, such as children with special healthcare needs, that show an association between HMH and increased ED utilization 25 . These results are also aligned with existing studies in patients with SCD showing that poverty, public health insurance, and difficulty paying bills are associated with increased ED utilization 13,17,28,29 . In our population, the number and presence of HMH remained independent variables for increased EDr even when controlling for insurance type.…”

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

“…This includes nonhematology specialists visits, before ED and hospitalizations for common complaints such as pain, as this is the most common reason for SCD patient hospitalization, is complex and difficult to manage. 35,36,49,50 These findings support the need for alternative care models. However, models such as the patient-centered medical home (PCMH) care model have been difficult to implement and for patients to access.…”

“…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.…”

“…Finally, a lack of follow-up care with the PCP or hematologist has also been consistently reported as an important factor associated with rehospitalizations and return to the ED within 30 days of discharge. 35,37,40,43,44 Outpatient Visits In addition to evaluating PCP visits and hematology visits, our study included data on the number of outpatient visits with various specialists. We found a large number of nonhematology specialty visits, many by PAs and NPs, and agerelated differences in the types of outpatient services utilized.…”

“…Studies of SCD patients have previously shown that the absence of a PCP and missing or forgetting outpatient visits were associated with both hospitalizations and rehospitalizations of SCD patients. 35,37 The effect of nonhematologist specialty visits on ED or inpatient health service utilization, in contrast, has not been reported. Information on the type of services provided by nonhematology specialists and the mechanisms (eg, referral processes) used by patients to access these services are needed.…”