Acute Care Utilization at End of Life in Sickle Cell Disease: Highlighting the Need for a Palliative Approach

2020 ◽  
Vol 23 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Emily E. Johnston ◽  
Oyebimpe O. Adesina ◽  
Elysia Alvarez ◽  
Heather Amato ◽  
Susan Paulukonis ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
End Of Life ◽  
Acute Care ◽  
Sickle Cell ◽  
Care Utilization ◽  
Cell Disease ◽  
Palliative Approach ◽  
Acute Care Utilization

Relationships between outpatient pain scores and acute care utilization in sickle cell disease

2012 ◽  
Vol 13 (4) ◽  
pp. S18
Author(s):  
D. Wilkie ◽  
M. Ezenwa ◽  
M. Suarez ◽  
Y. Kim ◽  
H. Wittert ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Acute Care ◽  
Sickle Cell ◽  
Care Utilization ◽  
Cell Disease ◽  
Pain Scores ◽  
Acute Care Utilization

Health Care Utilization By Age and Hydroxyurea Response in Pediatric and Adolescent Patients with Sickle Cell Disease

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2500-2500
Author(s):  
Emily Stewart ◽  
Amy Sobota
Keyword(s):  
Sickle Cell Disease ◽  
Acute Care ◽  
Sickle Cell ◽  
Conflicts Of Interest ◽  
Care Utilization ◽  
Patient Navigator ◽  
Inverse Association ◽  
Cell Disease ◽  
Acute Care Utilization ◽  
Clinic Visits

Abstract Background: Children and adolescents with sickle cell disease (SCD) have high rates of healthcare utilization which peak around the age of transition from pediatric to adult care. Adherence to evidence based care, including regular clinic visits, annual transcranial doppler (TCD) studies, and hydroxyurea (HU) use, is often suboptimal in this population. Over the past 4 years we have used a registry and patient navigator to improve access to routine care for our patients with SCD. We hypothesized that increased access to clinic and higher rates of HU use would positively impact acute care utilization. The purpose of this study was to 1) assess adherence to clinic visits and TCD rates, 2) describe patterns of acute care utilization, and 3) analyze the association between response to HU and acute care utilization in our patient cohort. Methods: We analyzed data on 208 unique patients with SCD between the ages of birth to 22 years of age who received care through the pediatric hematology program at BMC from April 2013 through March 2016. Demographics (age and genotype) and data on clinic visits, TCD screening, ED visits, inpatient stays, and HU use was obtained from the data ware house based on patients in our SCD registry. We calculated emergency department reliance (EDR), a ratio of clinic adherence relative to acute care utilization, for each patient. TCD rates and HU use were analyzed for patients with HbSS genotype only. Patient were stratified into three HU categories; patients not prescribed HU, those prescribed HU with a HbF response of less than 15%, and those prescribed HU with a HbF response of at least 15%. A Kruskal-Wallis test was used to analyze differences in rates of acute care utilization between the HU groups, Wilcoxon rank-sum test was used to assess whether EDR differed by HbF category, and Spearman's rank correlation was used to test for an association between HbF and EDR. Results: On average over the three year period 78% of patients had two clinic visits per year, 85% of eligible patients were prescribed HU and 96% had annual TCD screening. Acute care utilization was higher among older patients, consistent with the existing literature. Patients in the oldest age bracket had the highest mean EDR at 0.33 (Table 1). Among patients prescribed HU, increased HbF% was associated with lower rates of acute care utilization among all measures analyzed (Table 2). There was also a statistically significant, inverse association between HbF percentage and EDR of -0.2183 (p=0.0275). Conclusion: Through use of a SCD registry and patient navigator we have maintained adherence to biannual clinic visits, TCD screening, and HU uptake much higher than the rates reported in the literature. Our patients also had low rates of EDR at 0.23 which may reflect our clinic's accessibility. Increased levels of HbF, representing better adherence to HU, were associated with less acute care utilization, highlighting the importance of finding ways to increase adherence in our patient population. Disclosures No relevant conflicts of interest to declare.

scholarly journals Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit

2018 ◽  
Vol 36 (1) ◽  
pp. 88-92 ◽  
Author(s):  
Robert E. Molokie ◽  
Chariz Montminy ◽  
Corissa Dionisio ◽  
Muhammad Ahmen Farooqui ◽  
Michel Gowhari ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Acute Care ◽  
Sickle Cell ◽  
Care Utilization ◽  
Cell Disease ◽  
Acute Care Utilization ◽  
Acute Care Unit

scholarly journals Patients with Sickle Cell Disease and Venous Thromboembolism Experience Increased Frequency of Vasoocclusive Events

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 999-999
Author(s):  
Romy Carmen Lawrence ◽  
Sarah L Khan ◽  
Vishal Gupta ◽  
Brittany Scarpato ◽  
Rachel Strykowski ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Sickle Cell Disease ◽  
Acute Care ◽  
Sickle Cell ◽  
Hospital Admissions ◽  
Care Utilization ◽  
Cell Disease ◽  
History Of ◽  
Acute Care Utilization ◽  
Ed Visits

Introduction Patients with sickle cell disease (SCD) are at increased risk for venous thromboembolism (VTE). By age 40, 11-12% of SCD patients have experienced a VTE. VTE confers nearly a three-fold increase in mortality risk for individuals with SCD. We hypothesized that VTE increases subsequent SCD severity which may increase acute care utilization. We investigated the association between VTE and rates of vaso-occlusive events (VOE) and acute care utilization for individuals with SCD. Methods We performed a retrospective longitudinal chart review of 239 adults with SCD who received care at our institution between 2003 and 2018. VTE was defined as deep venous thrombosis (DVT) diagnosed by Duplex ultrasound or pulmonary embolism (PE) diagnosed by either ventilation-perfusion scanning or computed tomography angiography. Medical histories, laboratories and medication use for all subjects were obtained. For VTE patients, clinical data for 1- and 5- years post-VTE were obtained and compared to 1 year prior to the VTE. For non-VTE patients, data were obtained at baseline and compared to five years later. We evaluated all acute care visits for the presence of a SCD-related problem, specifically assessing if a VOE or acute chest syndrome (ACS) occurred. We calculated rates of VOE, ACS, Emergency Department (ED) visits and hospitalizations prior to and subsequent to a VTE and compared these to occurrence rates among those without VTE. Data were analyzed using Stata 14.2. Results In our cohort of 239 individuals with SCD, 153 (64%) were HbSS/HbSβ0 and 127(53%) were female. Fifty-six individuals (23%) had a history of VTE; 20 had a DVT (36%), 33 had a PE (59%), and 3 had both (5%). Patients with VTE had a higher frequency of prior history of ACS (p<0.001), stroke (p=0.013), splenectomy (p=0.033), and avascular necrosis (p<0.001) than those without a VTE. Prior to their VTE, these patients had higher white blood cell (11.8 x103 [9-15 x 103] vs 9.7 x103 [7-12 x 103], p=0.047) and platelet counts (378 x 103 [272-485 x 103] vs 322 x 103 [244-400 x 103], p=0.007) than those without a VTE. During five years of follow-up after a VTE, these patients had 6.32 (SD 14.97) ED visits per year compared to 2.84 (SD 5.93, p<0.03) ED visits per year in those without a VTE. Ninety two percent of these ED visits were SCD-related; 73% were for VOE and 4% for ACS. Additionally, SCD patients with a VTE had an increase in all-cause hospital admissions (2.84 [SD 3.26] vs 1.43 [SD 2.86], p=0.003) and SCD-related hospital admissions (2.61 [SD 3.13] vs 1.23 [SD 2.74], p=0.001) per year compared to those without VTE. Conclusion VTE is a frequent complication in patients with SCD. Our study suggests that patients who experience a VTE have greater SCD severity as evidenced by increased VOE, ED and hospital utilization. These data suggest that VTE is not merely an isolated event in SCD patients and that it may either serve as an indicator of disease severity or contribute to overall disease pathophysiology. Disclosures Sloan: Abbvie: Other: Endpoint Review Committee; Stemline: Consultancy; Merck: Other: endpoint review commitee.

scholarly journals Increased acute care utilization in a prospective cohort of adults with sickle cell disease

2018 ◽  
Vol 2 (18) ◽  
pp. 2412-2417 ◽  
Author(s):  
Sophie Lanzkron ◽  
Jane Little ◽  
Joshua Field ◽  
Joseph Ryan Shows ◽  
Hang Wang ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sickle Cell Disease ◽  
Acute Care ◽  
Sickle Cell ◽  
Acute Pain ◽  
Prospective Cohort ◽  
Care Utilization ◽  
Cell Disease ◽  
Acute Care Utilization

Abstract The ESCAPED (Examining Sickle Cell Acute Pain in the Emergency vs Day Hospital) trial is an ongoing prospective study comparing outcomes of people with sickle cell disease (SCD) seeking care for acute pain management in either an emergency department or specialty infusion clinic. The objective of this paper is to describe the baseline characteristics and health care utilization of patients in the trial. This is a multicenter study across 4 US cities that enrolled all adults with SCD living within 60 miles (96.6 km) of a study site who were expected to have acute care utilization over the study period. Twenty-one percent of participants had no acute care visits in the first 12 months of follow-up. Using negative binomial regression, we describe subject characteristics that predict acute care utilization. Three hundred ninety-one subjects have completed 12 months of follow-up with a mean age of 34.5 years (standard deviation, 11.4), 60% are female. Fifty-four percent of subjects with hemoglobin SS disease and 46% with hemoglobin SC disease had 3 or more acute visits over the study period. The prevalence of chronic pain in this cohort was 68%. Predictors of higher rates of acute care utilization included being unemployed, having chronic pain, being on chronic transfusion therapy, having a history of stroke, and being on disability or on Medicaid. This is the first prospective cohort in the modern era, and it demonstrates much higher rates of acute care utilization than reported in the Cooperative Study of Sickle Cell Disease.

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