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Shi JS, Sutaria A, Lakshmanan S, Attell B, Zhou M, Tang A, Eckman J, Snyder A. Immunization adherence among children with sickle cell disease and sickle cell trait: Results of a population-based study. Pediatr Blood Cancer 2024; 71:e31042. [PMID: 38702922 DOI: 10.1002/pbc.31042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Despite the importance of timely vaccine completion for protection from infectious disease, there is limited knowledge of the immunization adherence rates of children with sickle cell disease (SCD). METHODS This is a retrospective cohort study comparing the immunization rates of children with SCD to those with sickle cell trait between 2008 and 2019 in Georgia. Completion rates for each vaccine and the proportion of children with up-to-date status at 24 and 35 months were calculated and compared between the cohorts. Chi-square tests with odds ratios (OR) for differences and 95% confidence intervals (CIs) were reported on the overall up-to-date rates and rates for individual vaccines at 24 and 35 months for the two cohorts. RESULTS Children with SCD had higher up-to-date rates than children with sickle cell trait at 24 and 35 months. At 35 months, the overall up-to-date rates (OR = 1.17; 95% CI, 1.04-1.31; p = .004) and the four-dose pneumococcal conjugate vaccine series (OR = 1.36; 95% CI, 1.18-1.57; p < .001) were significantly different between the groups. Both cohorts had the highest completion rates for the hepatitis B series and the lowest rates for the varicella vaccine. Doses of diphtheria, tetanus, and acellular pertussis vaccine; varicella; and pneumococcal conjugate vaccines were most commonly missed by children in both cohorts. CONCLUSIONS Children with SCD have better immunization coverage than children with sickle cell trait, but there is an opportunity for improvement. Policymakers and healthcare professionals should focus on increasing access to care coordination services among children with SCD to ensure on-time and preventive healthcare services.
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Affiliation(s)
- Jiajing Scarlette Shi
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Ankit Sutaria
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Sangeetha Lakshmanan
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Brandon Attell
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Mei Zhou
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Amy Tang
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - James Eckman
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Angela Snyder
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
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Attell BK, McGee BT, DiGirolamo AM, Cohen LL, Snyder AB. Self-reported pain levels for emergency department visits associated with sickle cell disease in the United States. Blood Adv 2024; 8:1470-1473. [PMID: 38277505 PMCID: PMC10951903 DOI: 10.1182/bloodadvances.2023011127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/07/2023] [Accepted: 12/27/2023] [Indexed: 01/28/2024] Open
Affiliation(s)
| | - Blake T. McGee
- School of Nursing, Georgia State University, Atlanta, GA
| | | | | | - Angela B. Snyder
- Georgia Health Policy Center, Georgia State University, Atlanta, GA
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Reeves SL, Horiuchi S, Zhou M, Paulukonis S, Snyder A, Wilson-Frederick S, Hulihan M. Case Ascertainment of Sickle Cell Disease Using Surveillance or Single Administrative Database Case Definitions. Public Health Rep 2024; 139:187-194. [PMID: 37204194 PMCID: PMC10851905 DOI: 10.1177/00333549231166465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE In the absence of access to surveillance system data, single-source administrative databases are often used to study health care utilization and health outcomes among people with sickle cell disease (SCD). We compared the case definitions from single-source administrative databases with a surveillance case definition to identify people with SCD. MATERIALS AND METHODS We used data from Sickle Cell Data Collection programs in California and Georgia (2016-2018). The surveillance case definition for SCD developed for the Sickle Cell Data Collection programs uses multiple databases, including newborn screening, discharge databases, state Medicaid programs, vital records, and clinic data. Case definitions for SCD in single-source administrative databases varied by database (Medicaid and discharge) and years of data (1, 2, and 3 years). We calculated the proportion of people meeting the surveillance case definition for SCD that was captured by each single administrative database case definition for SCD, by birth cohort, sex, and Medicaid enrollment. RESULTS In California, 7117 people met the surveillance case definition of SCD from 2016 through 2018; 48% of this group was captured by the Medicaid case definition and 41% by the discharge case definition. In Georgia, 10 448 people met the surveillance case definition of SCD from 2016 through 2018; 45% of this group was captured by the Medicaid case definition and 51% by the discharge case definition. These proportions differed by years of data, birth cohort, and length of Medicaid enrollment. PRACTICE IMPLICATIONS The surveillance case definition identified twice as many people with SCD as the single-source administrative database definitions during the same period, but trade-offs exist in using single administrative databases for decisions on policy and program expansion for SCD.
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Affiliation(s)
- Sarah L. Reeves
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics and Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sophia Horiuchi
- Tracking California, Public Health Institute, Oakland, CA, USA
| | - Mei Zhou
- Andrew Young School of Policy Studies, Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
| | | | - Angela Snyder
- Andrew Young School of Policy Studies, Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
| | | | - Mary Hulihan
- Epidemiology and Surveillance Branch, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Attell BK, Barrett PM, Pace BS, McLemore ML, McGee BT, Oshe R, DiGirolamo AM, Cohen LL, Snyder AB. Characteristics of Emergency Department Visits Made by Individuals With Sickle Cell Disease in the U.S., 1999-2020. AJPM FOCUS 2024; 3:100158. [PMID: 38149076 PMCID: PMC10749880 DOI: 10.1016/j.focus.2023.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Introduction Individuals living with sickle cell disease experience high levels of morbidity that result in frequent utilization of the emergency department. The objective of this study was to provide updated national estimates of emergency department utilization associated with sickle cell disease in the U.S. Methods Data from the National Hospital Ambulatory Medical Care Survey for the years 1999-2020 were analyzed. Complex survey analysis was utilized to produce national estimates overall and by patient age groups. Results On average, approximately 222,612 emergency department visits occurred annually among individuals with sickle cell disease, a nearly 13% increase from prior estimates. The annual volume of emergency department visits steadily increased over time, and pain remains the most common patient-cited reason for visiting the emergency department. Patient-reported pain levels for individuals with sickle cell disease were high, with 64% of visits associated with severe pain and 21% associated with moderate pain. Public insurance sources continue to cover most visits, with Medicaid paying for 60% of visits and Medicare paying for 12% of visits. The average time spent in the emergency department increased from previous estimates by about an hour, rising to approximately 6 hours. The average wait time to see a provider was 53 minutes. Conclusions Utilization of the emergency department by individuals living with sickle cell disease remains high, especially for pain. With more than half of patients with sickle cell disease reporting severe pain levels, emergency department staff should be prepared to assess and treat sickle cell disease-related pain following evidence-based guidelines and recommendations. The findings of this study can help improve care in this population.
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Affiliation(s)
- Brandon K. Attell
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | | | - Betty S. Pace
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Morgan L. McLemore
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Blake T. McGee
- School of Nursing, Georgia State University, Atlanta, Georgia
| | - Rewo Oshe
- Department of Psychology, College of Arts & Sciences, Georgia State University, Atlanta, Georgia
| | - Ann M. DiGirolamo
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Lindsey L. Cohen
- Department of Psychology, College of Arts & Sciences, Georgia State University, Atlanta, Georgia
| | - Angela B. Snyder
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
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Pendergrast J, Ajayi LT, Kim E, Campitelli MA, Graves E. Sickle cell disease in Ontario, Canada: an epidemiologic profile based on health administrative data. CMAJ Open 2023; 11:E725-E733. [PMID: 37582620 PMCID: PMC10435244 DOI: 10.9778/cmajo.20220145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The number of patients with sickle cell disease in Ontario, Canada, is unknown. In the absence of a formal registry, we performed a study to determine an approximate census via analysis of health administrative databases. METHODS We identified Ontario patients with a diagnosis of sickle cell disease through queries of the Discharge Abstract Database, National Ambulatory Care Reporting System and Newborn Screening Ontario database. The period of inquiry was Apr. 1, 2007, through Mar. 31, 2017. We identified repeat interactions by the same patient by cross-referencing provincial health insurance plan numbers. RESULTS We documented health care system interactions for 3418 unique patients (1912 [55.9%] female, median age at the time of identification 24 yr). Over the 10-year study period, patients visited the emergency department a median of 2 (interquartile range [IQR] 1-7) times and an average of 6.69 (standard deviation [SD] 26.71) times, and were admitted to hospital a median of 1 (IQR 1-5) time and an average of 4.38 (SD 8.53) times for treatment related to sickle cell disease. A total of 229 patients (6.7%) died during the study period, with an average age at death of 55 years. Even without accounting for the effects of immigration, the rate of natural increase slowed slightly over the study period owing to a decrease in the annual number of affected births. INTERPRETATION The estimated prevalence of patients with sickle cell disease in Ontario in 2007/08-2016/17 was 1 in 4200, and affected patients' need for hospital-based care was substantial, although highly variable. Similar queries of health administrative databases may be feasible in other Canadian provinces.
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Affiliation(s)
- Jacob Pendergrast
- Department of Medical Oncology and Hematology (Pendergrast), University Health Network; Department of Medicine (Pendergrast), University of Toronto; Sickle Cell Awareness Group of Ontario (Tunji Ajayi); ICES Central (Kim, Campitelli, Graves), Toronto, Ont.
| | - Lanre Tunji Ajayi
- Department of Medical Oncology and Hematology (Pendergrast), University Health Network; Department of Medicine (Pendergrast), University of Toronto; Sickle Cell Awareness Group of Ontario (Tunji Ajayi); ICES Central (Kim, Campitelli, Graves), Toronto, Ont
| | - Eliane Kim
- Department of Medical Oncology and Hematology (Pendergrast), University Health Network; Department of Medicine (Pendergrast), University of Toronto; Sickle Cell Awareness Group of Ontario (Tunji Ajayi); ICES Central (Kim, Campitelli, Graves), Toronto, Ont
| | - Michael A Campitelli
- Department of Medical Oncology and Hematology (Pendergrast), University Health Network; Department of Medicine (Pendergrast), University of Toronto; Sickle Cell Awareness Group of Ontario (Tunji Ajayi); ICES Central (Kim, Campitelli, Graves), Toronto, Ont
| | - Erin Graves
- Department of Medical Oncology and Hematology (Pendergrast), University Health Network; Department of Medicine (Pendergrast), University of Toronto; Sickle Cell Awareness Group of Ontario (Tunji Ajayi); ICES Central (Kim, Campitelli, Graves), Toronto, Ont
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Tang AY, Zhou M, Maillis AN, Lai KW, Lane PA, Snyder AB. Trends in blood transfusion, hydroxyurea use, and iron overload among children with sickle cell disease enrolled in Medicaid, 2004-2019. Pediatr Blood Cancer 2023; 70:e30152. [PMID: 36579749 DOI: 10.1002/pbc.30152] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND There have been significant changes in clinical guidelines for sickle cell disease (SCD) over the past two decades, including updated indications for hydroxyurea, transfusions, and iron overload management. In practice however, there are few studies that examine SCD care utilization over time. METHODS We conducted a serial cross-sectional cohort study of pediatric SCD patients from 2004 to 2019 using Georgia Medicaid claims data. For each year, we reported receipt of any transfusion, chronic transfusion, or three or more filled hydroxyurea prescriptions. For children receiving chronic transfusion (six or more annual transfusions), we evaluated iron overload diagnosis, monitoring, and chelation use. Among children with sickle cell anemia (SCA), we examined rates of transfusions and hydroxyurea use. The Cochran-Armitage test was used to assess trend. RESULTS There were 5316 unique children 2-18 years old with SCD enrolled in Georgia Medicaid from 2004 to 2019. Children receiving any transfusion increased from 2004 to 2010, then stabilized. In SCA patients, chronic transfusions initially increased from 2004 to 2010, then stabilized from 2010 to 2019. For chronically transfused children, monitoring of iron burden and filled chelator prescriptions both increased significantly. Hydroxyurea use in SCA patients increased from 12% to 37%, with increases noted within each age group, most notably from 21% to 60% in the 13-18-year-old cohort. CONCLUSION We demonstrated changes in SCD care utilization over time, including increased hydroxyurea use, changes in transfusion rates, and increased attention to iron overload management. While trends in clinical management do follow updates in treatment guidelines, there is still delayed and suboptimal uptake of guideline recommendations in pediatric SCD patients.
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Affiliation(s)
- Amy Y Tang
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mei Zhou
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Alexander N Maillis
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kristina W Lai
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Peter A Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Angela B Snyder
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
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Adesina OO, Brunson A, Fisch SC, Yu B, Mahajan A, Willen SM, Keegan THM, Wun T. Pregnancy outcomes in women with sickle cell disease in California. Am J Hematol 2023; 98:440-448. [PMID: 36594168 PMCID: PMC9942937 DOI: 10.1002/ajh.26818] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
Adverse pregnancy outcomes occur frequently in women with sickle cell disease (SCD) across the globe. In the United States, Black women experience disproportionately worse maternal health outcomes than all other racial groups. To better understand how social determinants of health impact SCD maternal morbidity, we used California's Department of Health Care Access and Information data (1991-2019) to estimate the cumulative incidence of pregnancy outcomes in Black women with and without SCD-adjusted for age, insurance status, and Distressed Community Index (DCI) scores. Black pregnant women with SCD were more likely to deliver at a younger age, use government insurance, and live in at-risk or distressed neighborhoods, compared to those without SCD. They also experienced higher stillbirths (26.8, 95% confidence interval [CI]: 17.5-36.1 vs. 12.4 [CI: 12.1-12.7], per 1000 births) and inpatient maternal mortality (344.5 [CI: 337.6-682.2] vs. 6.1 [CI: 2.3-8.4], per 100 000 live births). Multivariate logistic regression models showed Black pregnant women with SCD had significantly higher odds ratios (OR) for sepsis (OR 14.89, CI: 10.81, 20.52), venous thromboembolism (OR 13.60, CI: 9.16, 20.20), and postpartum hemorrhage (OR 2.25, CI 1.79-2.82), with peak onset in the second trimester, third trimester, and six weeks postpartum, respectively. Despite adjusting for sociodemographic factors, Black women with SCD still experienced significantly worse pregnancy outcomes than those without SCD. We need additional studies to determine if early introduction to reproductive health education, continuation of SCD-modifying therapies during pregnancy, and increasing access to multidisciplinary perinatal care can reduce morbidity in pregnant women with SCD.
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Affiliation(s)
- Oyebimpe O. Adesina
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Samantha C. Fisch
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Bo Yu
- Department of Obstetrics & Gynecology, Stanford University School of Medicine; Stanford Maternal & Child Health Research Institute, Stanford, CA
| | - Anjlee Mahajan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Shaina M. Willen
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
- Division of Pediatric Pulmonary and Sleep Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Theresa H. M. Keegan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
- UC Davis Clinical and Translational Science Center, University of California, Davis, CA
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Barriteau CM, Feinglass J, Kayle M, VonAchen P, Liem RI, Badawy SM, Kan K. Emergency department visits and hospitalizations among patients with sickle cell disease in illinois, 2016-2020. Pediatr Hematol Oncol 2023; 40:70-75. [PMID: 35612367 DOI: 10.1080/08880018.2022.2071511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Sickle cell disease (SCD) state level surveillance data are limited. We performed a retrospective review of emergency department (ED) visits and hospitalizations from individuals with SCD in Illinois (2016-2020) using the Illinois Health and Hospital Association's Comparative Health Care and Hospital Data Reporting Services. There were 48,094 outpatient ED visits and 31,686 hospitalizations. Most visits (67%) occurred in Cook County, were covered by public insurance (77%) and were from individuals with medium high (40.3%) or high (36.1%) poverty levels. SCD healthcare utilization remains high and surveillance data may inform SCD program development and resource allocation at the state level.AbbreviationsCDCCenters for Disease Control and PreventionEDEmergency DepartmentFDAFood & Drug AdministrationICDInternational Classification of DiseasesILIllinoisSCDSickle cell disease.
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Affiliation(s)
- Christina M Barriteau
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Joe Feinglass
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mariam Kayle
- Clinical Health Systems and Analytics Division, Duke University School of Nursing, Durham, NC, USA
| | - Paige VonAchen
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Robert I Liem
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kristin Kan
- Department of Pediatrics, Division of Academic General Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern, University Feinberg School of Medicine, Chicago, IL, USA.,Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Snyder AB, Lakshmanan S, Hulihan MM, Paulukonis ST, Zhou M, Horiuchi SS, Abe K, Pope SN, Schieve LA. Surveillance for Sickle Cell Disease - Sickle Cell Data Collection Program, Two States, 2004-2018. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2022; 71:1-18. [PMID: 36201430 PMCID: PMC9552568 DOI: 10.15585/mmwr.ss7109a1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PROBLEM/CONDITION Sickle cell disease (SCD), an inherited blood disorder affecting an estimated 100,000 persons in the United States, is associated with multiple complications and reduced life expectancy. Complications of SCD can include anemia, debilitating acute and chronic pain, infection, acute chest syndrome, stroke, and progressive organ damage, including decreased cognitive function and renal failure. Early diagnosis, screenings and preventive interventions, and access to specialist health care can decrease illness and death. Population-based public health surveillance is critical to understanding the course and outcomes of SCD as well as the health care use, unmet health care needs, and gaps in essential services of the population affected by SCD. PERIOD COVERED 2004-2018. DESCRIPTION OF THE PROGRAM In 2015, CDC established the Sickle Cell Data Collection (SCDC) program to characterize the epidemiology of SCD in two states (California and Georgia). Previously, surveillance for SCD was conducted by two short-term projects: Registry and Surveillance System for Hemoglobinopathies (RuSH), which was conducted during 2010-2012 and included 2004-2008 data, and Public Health Research, Epidemiology, and Surveillance for Hemoglobinopathies (PHRESH), which was conducted during 2012-2014 and included 2004-2008 data. Both California and Georgia participated in RuSH and PHRESH, which guided the development of the SCDC methods and case definitions. SCDC is a population-based tracking system that uses comprehensive data linkages in state health systems. These linkages serve to synthesize and disseminate population-based, longitudinal data for persons identified with SCD from multiple sources using selected International Classification of Diseases, Ninth Revision, Clinical Modification, and Tenth Revision codes and laboratory results confirmed through state newborn screening (NBS) programs or clinic case reporting. Administrative and clinical data sources include state Medicaid and Children's Health Insurance Program databases, death certificates, NBS programs, hospital discharge and emergency department records, and clinical records or case reports. Data from multiple sources and years are linked and deduplicated so that states can analyze and report on SCD population prevalence, demographic characteristics, health care access and use, and health outcomes. The SCD case definition is based on an algorithm that classifies cases with laboratory confirmation as confirmed cases and those with a reported clinical diagnosis or three or more diagnostic codes over a 5-year period from an administrative data source as probable cases. In 2019, nine states (Alabama, California, Georgia, Indiana, Michigan, Minnesota, North Carolina, Tennessee, and Virginia) were funded as part of an SCDC capacity-building initiative. The newly funded states developed strategies for SCD case identification and data linkage similar to those used by California and Georgia. As of 2021, the SCDC program had expanded to 11 states with the addition of Colorado and Wisconsin. RESULTS During 2004-2018, the cumulative prevalence of confirmed and probable SCD cases identified in California and Georgia was 9,875 and 14,777 cases, respectively. The 2018 annual prevalence count was 6,027 cases for California and 9,141 for Georgia. Examination of prevalence counts by contributing data source during 2014-2018 revealed that each data source captured 16%-71% of cases in California and 17%-87% in Georgia; therefore, no individual source is sufficient to estimate statewide population prevalence. The proportion of pediatric SCD patients (children aged 0-18 years) was 27% in California and 40% in Georgia. The percentage of females with SCD in California and Georgia was 58% and 57%, respectively. Of the cases with SCD genotyping data available (n = 5,856), 63% of patients had sickle cell anemia. SCDC data have been used to directly apprise health care providers and policymakers about health care needs and gaps for patients with SCD. For example, an SCDC Georgia assessment indicated that 10% of babies born during 2004-2016 with SCD lived more than a 1-hour drive from any SCD specialty care option, and another 14% lived within a 1-hour drive of a periodic SCD specialty clinic only. Likewise, an SCDC California assessment indicated that during 2016-2018, most patients with SCD in Los Angeles County lived approximately 15-60 miles from hematologists experienced in SCD care. A surveillance capacity and performance assessment of all 11 SCDC states during 2020-2021 indicated that states differed in the availability of data sources used for SCD surveillance and the time frames for accessing each state data source. Nonetheless, methods for standardizing reporting were developed across all participating states. INTERPRETATION This report is the first comprehensive description of CDC's efforts in collaboration with participating states to establish, maintain, and expand SCD surveillance through the SCDC program to improve health outcomes for persons living with SCD. Findings from California and Georgia analyses highlighted a need for additional SCD specialty clinics. Despite different approaches, expansion of SCDC to multiple states was possible using standardized, rigorous methods developed across all participating states for reporting on disease prevalence, health care needs and use, and deaths. PUBLIC HEALTH ACTION Findings from surveillance can be used to improve and monitor care and outcomes for persons with SCD. These and other SCDC analyses have had a role in opening new SCD clinics, educating health care providers, developing state health care policies, and guiding new research initiatives. Public health officials can use this report as a guiding framework to plan or implement surveillance programs for persons with SCD. Both data-related activities (data sources; patient identifiers; and obtaining, transferring, and linking data) and the administrative considerations (stakeholder engagement, costs and resources, and long-term sustainability) are crucial to the success of these programs.
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Alavian S, Asare‐Agbo P, Chan TM. Systematic online academic resources (SOAR) review: Sickle cell disorders. AEM EDUCATION AND TRAINING 2022; 6:e10812. [PMID: 36258904 PMCID: PMC9562367 DOI: 10.1002/aet2.10812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Background Free open-access medical education (FOAM) resources have become highly utilized resources in emergency medicine education. However, FOAM content often lacks the traditional peer review process, leaving quality assessment to the readers. In this systematic online academic resource (SOAR) review, we apply a systematic methodology to assess the quality of FOAM resources on sickle cell disease (SCD). Methods We searched keywords for SCD using FOAM Search and the top 50 FOAM websites listed on the Social Media Index. Resources found were screened using inclusion/exclusion criteria, and a total of 53 resources underwent full-text quality assessment using the revised Medical Education Translational Resources Impact and Quality (rMETRIQ) tool. Results The search yielded 520 resources, of which 53 met the criteria for quality assessment. A total of eight posts (15.1% of posts) were identified as high quality (rMETRIQ ≥ 16). The most commonly addressed topics within SCD topics included acute chest syndrome, acute pain crisis and general review of SCD. A total of 11 posts (21% of posts) were found to have an rMETRIQ score of less than 7, which may indicate poor quality. The most commonly identified type of resource was personalized reading (64%) and a number of posts were deemed to not have an appropriate use due to poor quality (15%). Conclusions We were able to systematically search a wide range of resources to identify, appraise, and organize FOAM resources on the topic of SCD. A final list of eight high-quality resources can guide trainees, educator recommendations, and FOAM authors.
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Affiliation(s)
- Sara Alavian
- Royal College Emergency Medicine Training Program, Division of Emergency Medicine, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Prince Asare‐Agbo
- Department of Emergency Medicine, The Ottawa HospitalUniversity of OttawaOttawaOntarioCanada
| | - Teresa M. Chan
- Department of Medicine, Division of Emergency Medicine McMaster ClinicsMcMaster UniversityHamiltonOntarioCanada
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Smith WR, McClish DK, Bovbjerg VE, Singh HK. Development and validation of the sickle cell stress scale-adult. Eur J Haematol 2022; 109:215-225. [PMID: 35585659 PMCID: PMC9531901 DOI: 10.1111/ejh.13789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Disease-specific stress can partly explain Sickle Cell Disease (SCD) healthcare utilization. We developed and validated two measures of adult SCD-specific stress for research and clinical care. A large cohort of adults with SCD completed both the 3-item Likert-scale adapted from a previous disease stress measure and a 10-item Likert-scale questionnaire drafted specifically to measure SCD stress. They concurrently completed a psychosocial and health-related quality of life scale battery, then subsequently daily pain diaries. Diaires measured: daily intensity, distress and interference of pain; self-defined vaso-occlusive crises (VOC), opioid use, and types of healthcare utilization for up to 24 weeks. Analyses tested Cronbach's alpha, correlation of the three-item and 10-item stress scales with the concurrent battery, with percentages of pain days, VOC days, opioid use days, and healthcare utilization days, and correlation of baseline stress and 6-month stress for the 10-item scale. Cronbach's alpha was high for both the 3-item (0.73) and 10-item (0.83) SCD stress scales, test-retest correlation of 0.55, expected correlation with the concurrent battery, and correlation with diary-measured healthcare utilization over 6 months. The correlations with the 3-item scale were stronger, but only statistically significant for depression-anxiety. The correlation between the two stress scales was 0.59. Both the 3-item and the 10-item stress scales exhibited good face, construct, concurrent, and predictive validity as well as moderate test-retest reliability. Further scale validation should determine population norms and response to interventions.
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Grants
- U10 HL083732 NHLBI NIH HHS
- U54 HL090516 NHLBI NIH HHS
- R01 HL064122 NHLBI NIH HHS
- R18 HL112737 NHLBI NIH HHS
- Pain in Sickle Cell Epidemiology Study, 1 R01 HL 64122, National Heart, Lung, and Blood Institute
- A.D. Williams Faculty Research Grant, Virginia Commonwealth University
- Virginia Basic and Translational Research Program in Sickle Cell Disease. 1U54HL090516, National Heart, Lung, and Blood Institute
- A.D. Williams Student Research Fellowships, Virgin ia Commonwealth University
- Enhancing Use of Hydroxyurea In Sickle Cell Disease Using Patient Navigators
- Clinical Research Training Program, National Institutes of Health
- Sickle Cell Disease Clinical Research Network, National Heart, Lung, and Blood Institute 1U10HL083732
- Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Award (1993-1997)
- VCU School of Medicine Student Fellowships
- Enhancing Use of Hydroxyurea In Sickle Cell Disease Using Patient Navigators (NCT02197845, 1 R18 HL 112737, National Heart, Lung, and Blood Institute
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Affiliation(s)
- Wally R. Smith
- Section of Research, Division of General Internal MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Donna K. McClish
- Department of BiostatisticsVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Viktor E. Bovbjerg
- College of Health and Human SciencesOregon State UniversityCorvallisOregonUSA
| | - Harjot K. Singh
- Division of Infectious DiseasesWeill Cornell MedicineNew YorkNew YorkUSA
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12
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Moody KL. Healthcare utilization and the quality of life of children and adolescents with sickle cell disease. Pediatr Blood Cancer 2022; 69:e29685. [PMID: 35373909 DOI: 10.1002/pbc.29685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVE Youth diagnosed with sickle cell disease (SCD) are at increased risk of poor health-related quality of life (HRQOL) due to the complexities associated with this disease. The literature notes that predictors such as pain and poor mental health are associated with increased healthcare access; however, the connection between healthcare use and their overall well-being has been understudied. This study investigates whether healthcare utilization predicts the HRQOL in youth with SCD. DESIGN/METHODS Patients completed the Pediatric Quality of Life (PedsQL) 3.0 SCD module, whereas the researcher conducted a retrospective chart review to gather patient characteristics such as emergency room (ER) and hospitalization occurrences over the past 12 months. RESULTS The study consisted of 150 pediatric patients with SCD, ages 8-17 years old, and their parents. Patients with ≥ 4 ER visits and hospitalizations reported worse HRQOL scores than their respective counterparts. Additionally, a higher frequency of ER visits (P = 0.05) and hospitalizations (P = 0.005) predicted lower HRQOL scores. Age (P = 0.04) also emerged as a significant predictor for both regression models, as increased healthcare access among older patients with SCD was associated with poorer HRQOL. CONCLUSION This study found that as youth with SCD require ER treatment and/or hospital admission, they are at increased risk for lower HRQOL, specifically as they get older. Findings suggest that attention should be paid to patients who require more frequent healthcare intervention. Improvement in outpatient care of pediatric patients with SCD may help to mitigate ER and inpatient use.
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Affiliation(s)
- Kendall L Moody
- School of Social Work, Howard University, Washington, District of Columbia
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13
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Wachnik AA, Welch-Coltrane JL, Adams MCB, Blumstein HA, Pariyadath M, Robinson SG, Saha A, Summers EC, Hurley RW. A Standardized Emergency Department Order Set Decreases Admission Rates and In-Patient Length of Stay for Adults Patients with Sickle Cell Disease. PAIN MEDICINE 2022; 23:2050-2060. [PMID: 35708651 PMCID: PMC9714532 DOI: 10.1093/pm/pnac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/20/2022] [Accepted: 06/10/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Pain associated with sickle cell disease (SCD) causes severe complications and frequent presentation to the emergency department (ED). Patients with SCD frequently report inadequate pain treatment in the ED, resulting in hospital admission. A retrospective analysis was conducted to assess a quality improvement project to standardize ED care for patients presenting with pain associated with SCD. METHODS A 3-year prospective quality improvement initiative was performed. Our multidisciplinary team of providers implemented an ED order set in 2019 to improve care and provide adequate analgesia management. Our primary outcome was the overall hospital admission rate for patients after the intervention. Secondary outcome measures included ED disposition, rate of return to the ED within 72 hours, ED pain scores at admission and discharge, ED treatment time, in-patient length of stay, non-opioid medication use, and opioid medication use. RESULTS There was an overall 67% reduction in the hospital admission rate after implementation of the order set (P = 0.005) and a significant decrease in the percentage admission rate month over month (P = 0.047). Time to the first non-opioid analgesic decreased by 71 minutes (P > 0.001), and there was no change in time to the first opioid medication. The rate of return to the ED within 72 hours remained unchanged (7.0% vs 7.1%) (P = 0.93), and the ED elopement rate remained unchanged (1.3% vs 1.85%) (P = 0.93). After the implementation, there were significant increases in the prescribing of orally administered acetaminophen (7%), celecoxib (1.2%), and tizanidine (12.5%) and intravenous ketamine (30.5%) and ketorolac (27%). ED pain scores at discharge were unchanged for both hospital-admitted (7.12 vs 7.08) (P = 0.93) and non-admitted (5.51 vs 6.11) (P = 0.27) patients. The resulting potential cost reduction was determined to be $193,440 during the 12-month observation period, with the mean cost per visit decreasing by $792. CONCLUSIONS Use of a standardized and multimodal ED order set reduced hospital admission rates and the timeliness of analgesia without negatively impacting patients' pain.
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Affiliation(s)
| | | | | | | | | | | | - Amit Saha
- Department of Anesthesiology and Pain Service Line
| | - Erik C Summers
- Department of Internal Medicine Section of Hospital Medicine
| | - Robert W Hurley
- Correspondence to: Robert W. Hurley, MD, PhD, FASA, Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27051, USA. Tel: 336-716-2266; Fax: 336-716-8773; E-mail:
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14
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Pompeo CM, Ferreira Júnior MA, Cardoso AIDQ, Souza MDC, Frota OP, Mota FM, Ivo ML. Clinical-Epidemiological Characteristics and Mortality in Patients with Sickle Cell Anemia: A Retrospective Cohort Study of 1980 at 2018. Int J Gen Med 2022; 15:1057-1074. [PMID: 35140508 PMCID: PMC8818769 DOI: 10.2147/ijgm.s342971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/07/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To analyze the clinical-epidemiological characteristics and mortality in patients with sickle-cell anemia (SCA). PATIENTS AND METHODS A cohort study with retrospective data, conducted in two reference hospitals for SCA treatment from January 1980 to December 2018, recorded in two reference services. With a 5% significance level, the Chi-Square and Student's t-tests were employed in the inferential statistical analysis. RESULTS A total of 128 patients with SCA were studied. Diagnosis up to the fifth day of life was made in 10 patients. There were 19 deaths, of which 12 (63.2%) were female, and the average age at death was 27.05 (± 14.78) years. The leading causes of death were septic shock and cardiogenic shock. The use of invasive medical devices was considered a risk factor for death (RR=2.63; 95% CI=1.16-5.96; p=0.018), and monitoring time up to 20 years presented a 31% reduction in the risk of dying (RR=0.31; 95% CI=0.12-0.82; p=0.011) when compared to the monitoring of more than 20 years. CONCLUSION These findings are to be considered in the treatment of patients with SCA, mainly regarding early diagnosis and access to the treatment immediately afterward, since they are fundamental in improving survival and reducing severe complications.
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Affiliation(s)
- Carolina Mariano Pompeo
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | - Mercy da Costa Souza
- Graduate Program in Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Oleci Pereira Frota
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Felipe Machado Mota
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Maria Lúcia Ivo
- Graduate Program in Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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15
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Lobo C, Moura P, Fidlarczyk D, Duran J, Barbosa R, Oliveira T, do Nascimento EM, Bhakta N, Hankins JS. Cost analysis of acute care resource utilization among individuals with sickle cell disease in a middle-income country. BMC Health Serv Res 2022; 22:42. [PMID: 34998394 PMCID: PMC8742916 DOI: 10.1186/s12913-021-07461-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The costs associated with the treatment of sickle cell disease (SCD) are understudied in low and middle-income countries (LMIC). We evaluated the cost of treating SCD-related acute complications and the potential cost-savings of hydroxyurea in a specialized hematology center in Brazil. METHODS The costs (US dollars) of emergency department (ED) and hospitalizations from SCD-related complications between 01.01.2018 and 06.30.2018 were ascertained using absorption and micro-costing approaches. The reasons for acute hospital visits were grouped as: 1) vaso-occlusive (VOC) pain, 2) infection, 3) anemia exacerbation, and 4) chronic organ damage complications. Hydroxyurea adherence was estimated by medication possession ratio (MPR) during the study period. RESULTS In total, 1144 patients, median age 17 years (range 0-70), 903 (78.9%) with HbSS/HbSβ0-thalassemia, 441 (38.5%) prescribed hydroxyurea, visited the ED, of whom 381 (33%) were admitted. VOC accounted for 64% of all ED visits and 60% of all admissions. Anemia exacerbation was the most expensive reason for ED visit ($321.87/visit), while chronic organ damage carried the highest admission cost ($2176.40/visit). Compared with other genotypes, individuals with HbSS/HbSβ0-thalassemia were admitted more often (79% versus 21%, p < 0.0001), and their admission costs were higher ($1677.18 versus $1224.47/visit, p = 0.0001). Antibiotics and analgesics accounted for 43% and 42% of the total ED costs, respectively, while housing accounted for 46% of the total admission costs. Costs of ED visits not resulting in admissions were lower among HbSS/HbSβ0-thalassemia individuals with hydroxyurea MPR ≥65% compared with visits by patients with MPR <65% ($98.16/visit versus $182.46/visit, p = 0.0007). No difference in admission costs were observed relative to hydroxyurea use. DISCUSSION In a LMIC hematology-specialized center, VOCs accounted for most acute visits from patients with SCD, but costs were highest due to anemia exacerbation. Analgesics, antibiotics, and housing drove most expenses. Hydroxyurea may reduce ED costs among individuals with HbSS/HbSβ0-thalassemia but is dependent on adherence level.
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Affiliation(s)
- Clarisse Lobo
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Patricia Moura
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Delaine Fidlarczyk
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Jane Duran
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Roberto Barbosa
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Thais Oliveira
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Emilia Matos do Nascimento
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
- Fundação Centro Universitário Estadual da Zona Oeste UEZO, Rio de Janeiro, Brazil
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, 262 Danny Thomas Place, TN, 38105, Memphis, USA
| | - Jane S Hankins
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, 262 Danny Thomas Place, TN, 38105, Memphis, USA.
- Department of Hematology, St. Jude Children's Research Hospital, TN, 38105, Memphis, USA.
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16
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Kanter J, Meier ER, Hankins JS, Paulukonis ST, Snyder AB. Improving Outcomes for Patients With Sickle Cell Disease in the United States. JAMA HEALTH FORUM 2021; 2:e213467. [DOI: 10.1001/jamahealthforum.2021.3467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Julie Kanter
- Division of Hematology and Oncology, University of Alabama Birmingham, Birmingham
| | | | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Angela B. Snyder
- Georgia Health Policy Center and the Department of Public Management and Policy, Andrew Young School of Policy Studies, Georgia State University, Atlanta
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17
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Shukla N, Barner JC, Lawson KA, Rascati KL. Age-related healthcare services utilization for the management of sickle cell disease among treated Texas Medicaid patients. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
To determine if there are age-related differences in sickle cell disease (SCD)-related healthcare utilization and to describe temporal healthcare utilization following an emergency department (ED) visit or hospitalization in treated SCD patient population.
Methods
Texas Medicaid prescription and medical claims from 1 September 2011 to 31 August 2016 were used. Patients aged 2–63 years with at least one inpatient or outpatient SCD medical claim and receiving one or more SCD-related medications (hydroxyurea, opioid or non-opioid analgesics) were included. The primary outcomes were utilization of SCD-related ED, inpatient and outpatient visits, all-cause prescription medications and type of SCD-related service at index and subsequent healthcare services. Age group was the primary independent variable.
Key findings
Overall (N = 2339), healthcare service utilization was relatively higher among age groups 2–12, 18–25 and 26–40. Proportions of patients having ≥1 ED and ≥1 inpatient visits, respectively, were significantly higher among age groups 2–12 (33.2%; 23.0%), 18–25 (29.3%; 25.1%) and 26–40 (32.3%; 22.4%) as compared with age group 13–17 (21.3%; 12.9%). The number of outpatient visits was highest among children aged 2–12 (4.5 ± 7.6, P < 0.0001), while mean number of all-cause medications was the highest for older adults aged 41–63 (22.4 ± 16.3; P < 0.0001). After an index ED visit (N = 598), outpatient visits were the most prevalent healthcare services. After an index hospitalization (N = 203), a subsequent hospitalization was the most prevalent healthcare service.
Conclusions
Texas Medicaid SCD patients receiving treatment have a high use of healthcare services, especially among children and young adults who are transitioning from childhood to adulthood. Age-specific interventions should be developed to promote optimal care transitions among young adults.
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Affiliation(s)
- Nidhi Shukla
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Jamie C Barner
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Kenneth A Lawson
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Karen L Rascati
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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18
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Narh CT, Der J, Ofosu A, Blettner M, Wollschlaeger D. Time trends, sociodemographic and health factors associated with discharge and length of stay of hospitalised patients with sickle cell disease in Ghana: a retrospective analysis of national routine health database. BMJ Open 2021; 11:e048407. [PMID: 34610933 PMCID: PMC8493906 DOI: 10.1136/bmjopen-2020-048407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Patients with sickle cell disease (SCD) are prone to multiple episodes resulting in frequent hospital visits. We determined the time trends, sociodemographic and health factors associated with length of stay (LoS) for patients with SCD in Ghana. DESIGN, PARTICIPANTS, SETTING We retrospectively analysed SCD hospitalisation records of 22 680 patients from a nationwide database of the Ghana Health Service from 2012 to 2017. OUTCOME MEASURES Factors associated with LoS were estimated using Cox regression, while the cumulative incidence of being discharged alive was estimated with in-hospital death as a competing risk. RESULTS Patients admitted for SCD over 6 years constituted 22 680 (0.8%) of nearly 3 million admissions. The median age and LoS for the patients were 16 years (IQR=8-24) and 3 days (IQR=2-4), representing 14 202 (62.6%) of the patients discharged alive by the third day. Patients with sickle cell anaemia (6139, 52.6%) with a crisis were more frequent than those without a crisis. Increasing age was associated with shorter LoS when comparing age groups 10-14 years (HR=1.08, 95% CI 1.01 to 1.14) and 25-29 years (HR=1.27, 95% CI 1.17 to 1.37) to patients aged 0-4 years. Patients with comorbidities had a longer LoS compared with those without (HR=0.88, 95% CI 0.86 to 0.90). CONCLUSION This is the largest study to date documenting factors associated with LoS for patients admitted for SCD. The association of younger age with increased LoS supports recent calls for early SCD screening, especially newborns. The emerging trends and factors accounting for SCD admission require a multisector approach as these patients already experience frequent episodes of pain and hospital visits.
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Affiliation(s)
- Clement Tetteh Narh
- Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
- Biostatistics, Johannes-Gutenberg Universitat Mainz Institut für Medizinische Biometrie Epidemiologie und Informatik, Mainz, Rheinland-Pfalz, Germany
| | - Joyce Der
- Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Anthony Ofosu
- Policy, Planning, Monitoring and Evaluation Division (PPMED), Ghana Health Service, Accra, Greater Accra, Ghana
| | - Maria Blettner
- Radiation Epidemiology, Johannes-Gutenberg Universitat Mainz Institut für Medizinische Biometrie Epidemiologie und Informatik, Mainz, Rheinland-Pfalz, Germany
| | - Daniel Wollschlaeger
- Radiation Epidemiology, Johannes-Gutenberg Universitat Mainz Institut für Medizinische Biometrie Epidemiologie und Informatik, Mainz, Rheinland-Pfalz, Germany
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19
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Wong TE, Valle J, Paulukonis S. Concurrent use of hydroxyurea and deferasirox in Californians with sickle cell disease. Health Sci Rep 2021; 4:e323. [PMID: 34277954 PMCID: PMC8279216 DOI: 10.1002/hsr2.323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/28/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIMS When patients with sickle cell disease have appropriate indications, they can be prescribed hydroxyurea (HU) and deferasirox (DFX) concurrently despite little knowledge about how the two medications interact. We wished to analyze whether there was evidence of adverse interaction between HU and DFX when taken simultaneously and hypothesized that those who took both drugs together had similar clinical complications when compared to those who took only one or neither drug. METHODS We conducted this retrospective cohort investigation between 2009 and 2016 of persons with SCD in the California Sickle Cell Data Collection Program, a validated database of Californians with SCD a statewide. People in the database who took HU and DFX simultaneously for at least 3 months as compared to those who took either HU or DFX alone or to matched persons who took neither drug were eligible. RESULTS We identified 104 people who were prescribed both HU and DFX concurrently, 877 who were prescribed HU only, and 314 who were prescribed DFX only during the study period. We identified 416 matched controls who took neither HU nor DFX. People who took both HU and DFX concurrently had similar rates of ED and inpatient encounters and had similar rates and distribution of adverse effects compared to those who took either HU or DFX alone or took neither drug. CONCLUSION Three months of concurrent use of DFX and HU appears safe, but further studies are required to better understand the safety and effectiveness of this medication combination. (Funded by CDC, CDC Foundation, and others).
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Affiliation(s)
- Trisha E. Wong
- Division of Pediatric Hematology/Oncology and Department of PathologyOregon Health and Sciences UniversityPortlandOregonUSA
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20
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Maddray AB, Phillips SM. Instruments to Measure Perceptions in the Emergency Department Provider-Patient with Sickle Cell Disease Interaction: Findings of an Integrative Review from a Ph.D. Project. Open Nurs J 2020. [DOI: 10.2174/1874434602014010263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background & Purpose:
The purpose of this review is to examine instruments that measure providers' perceptions of adult patients with Sickle Cell Disease (SCD), examine instruments that measure adult patients with SCD perceptions of providers' behaviors, and determine optimal instruments to use in evaluating the perceptions of Emergency Department (ED) providers and adult patients with SCD of one another's behaviors after an interaction in the ED.
Methods:
An integrative review was conducted searching EBSCOhost and PubMed databases using the keywords: measure [OR] measure* [OR] assess* [OR] scale [OR] survey [OR] tool [AND] stigma* [OR] stereotype [OR] prejudice [OR] bias [OR] perception [OR] attitude [OR] discrimination [OR] racism [OR] behavior [AND] interaction [OR] relationship [OR] communication [AND] sickle cell. Initial search located 256 articles, but only 15 articles were included in the final review.
Results:
Fifteen articles reporting six instruments were reviewed. Four instruments evaluated a provider’s perceptions of patients with SCD behaviors, and two instruments evaluated how patients with SCD perceived provider behaviors. The two patient-focused instruments and three provider-focused instruments were found to be adequately reliable and valid according to the Psychometric Grading Framework (PGF).
Conclusions:
The findings suggest that the General Perceptions About Sickle Cell Disease Patients Scale would be an optimal instrument to evaluate ED providers' perceptions of adult patients with SCD behaviors. One patient-focused instrument, The Sickle Cell Health-Related Stigma Scale (SCD-HRSS), reported adequate reliability and validity but was not specific to measuring the patient's perceptions of ED providers' behaviors, nor was it administered in the ED environment. The SCD-HRSS Doctors subscale has potential adaptability for use in measuring patients with SCD perceptions of ED provider behaviors in the ED environment.
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21
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Grosse SD, Green NS, Reeves SL. Administrative data identify sickle cell disease: A critical review of approaches in U.S. health services research. Pediatr Blood Cancer 2020; 67:e28703. [PMID: 32939942 PMCID: PMC7606824 DOI: 10.1002/pbc.28703] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022]
Abstract
To identify people living with sickle cell disease (SCD) and study their healthcare utilization, researchers can either use clinical records linked to administrative data or use billing diagnosis codes in stand-alone administrative databases. Correct identification of individuals clinically managed for SCD using diagnosis codes in claims databases is limited by the accuracy of billing codes in outpatient encounters. In this critical review, we assess the strengths and limitations of claims-based SCD case-finding algorithms in stand-alone administrative databases that contain both inpatient and outpatient records. Validation studies conducted using clinical records and newborn screening for confirmation of SCD case status have found that algorithms that require three or more nonpharmacy claims or one inpatient claim plus two or more outpatient claims with SCD codes show acceptable accuracy (positive predictive value and sensitivity) in children and adolescents. Future studies might seek to assess the accuracy of case-finding algorithms over the lifespan.
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Affiliation(s)
- Scott D. Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - Nancy S. Green
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | - Sarah L. Reeves
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan,School of Public Health, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
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22
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Abdallah K, Buscetta A, Cooper K, Byeon J, Crouch A, Pink S, Minniti C, Bonham VL. Emergency Department Utilization for Patients Living With Sickle Cell Disease: Psychosocial Predictors of Health Care Behaviors. Ann Emerg Med 2020; 76:S56-S63. [PMID: 32928463 PMCID: PMC7486179 DOI: 10.1016/j.annemergmed.2020.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Study objective Individuals living with sickle cell disease (SCD) often require urgent care; however, some patients hesitate to present to the emergency department (ED), which may increase the risk of serious clinical complications. Our study aims to examine psychosocial, clinical, and demographic factors associated with delaying ED care. Methods This was a cross-sectional study of 267 adults with SCD from the national INSIGHTS Study. The binary outcome variable asked whether, in the past 12 months, participants had delayed going to an ED when they thought they needed care. Logistic regression was performed with clinical, demographic, and psychosocial measures. Results Approximately 67% of the participants reported delaying ED care. Individuals who delayed care were more likely to have reported higher stigma experiences (odds ratio [OR]=1.09; 95% confidence interval [CI] 1.03 to 1.16), more frequent pain episodes (OR=1.15; 95% CI 1.01 to 1.32), lower health care satisfaction (OR= 0.74; 95% CI 0.59 to 0.94), and more frequent ED visits (OR=6.07; 95% CI 1.18 to 31.19). Disease severity and demographics, including sex, age, and health insurance status, were not significantly associated with delay in care. Conclusion Psychosocial factors, including disease stigma and previous negative health care experiences, are associated with delay of ED care in this SCD cohort. There is a need to further investigate the influence of psychosocial factors on the health care–seeking behaviors of SCD patients, as well as the downstream consequences of these behaviors on morbidity and mortality. The resulting knowledge can contribute to efforts to improve health care experiences and patient-provider relationships in the SCD community.
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Affiliation(s)
- Khadijah Abdallah
- Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD.
| | - Ashley Buscetta
- Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD
| | - Kayla Cooper
- Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD
| | - Julia Byeon
- Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD
| | - Andrew Crouch
- Division of Hematology/Sickle Cell Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Sabrina Pink
- Division of Hematology/Sickle Cell Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Caterina Minniti
- Division of Hematology/Sickle Cell Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Vence L Bonham
- Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD
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Kavanagh PL, Hirshon JM. EDSC 3: Working to Improve Emergency Department Care of Individuals With Sickle Cell Disease. Ann Emerg Med 2020; 76:S80-S82. [PMID: 32928468 DOI: 10.1016/j.annemergmed.2020.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Patricia L Kavanagh
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA.
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
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24
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Giroir BP, Collins F. The State of Sickle Cell Disease Care in the United States: How Can Emergency Medicine Contribute? Ann Emerg Med 2020; 76:S1-S3. [PMID: 32928456 PMCID: PMC7486208 DOI: 10.1016/j.annemergmed.2020.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Brett P Giroir
- Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services, Washington, DC.
| | - Felicia Collins
- Office of Minority Health, Office of the Secretary, US Department of Health and Human Services, Rockville, MD
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25
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Lee S, Vania DK, Bhor M, Revicki D, Abogunrin S, Sarri G. Patient-Reported Outcomes and Economic Burden of Adults with Sickle Cell Disease in the United States: A Systematic Review. Int J Gen Med 2020; 13:361-377. [PMID: 32753936 PMCID: PMC7354084 DOI: 10.2147/ijgm.s257340] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To systematically estimate the patient-reported outcomes (PROs) and economic burden of sickle cell disease (SCD) among adults in the United States (US). Patients and Methods Two systematic literature reviews (SLRs), one each for the PROs and economic topics, were performed using MEDLINE and Embase to identify observational studies of adults with SCD. Included studies were published between 2007 and 2018 and evaluated health-related quality of life (HRQL), function, healthcare resource utilization (HCRU), or costs. Given the high degree of clinical and methodological heterogeneity, findings were summarized qualitatively. Results The SLRs identified 7 studies evaluating the PROs and 15 studies evaluating the economic burden meeting the pre-specified selection criteria. The PRO evidence showed the prevalence of depression and anxiety to be 21–33% and 7–36%, respectively, in adults with SCD. The mean SF-36 physical summary scores ranged from 33.6 to 59.0 and from 46.3 to 61.5 for the mental summary scores. Overall HRQL for adults with SCD was poor and significantly worse in those with opioid use. Adult SCD patients were found to have varying rates of emergency department (ED) utilization (0.3–3.5 annual ED visits), hospitalizations (0.5–27.9 per patient per year), and/or readmission (12–41%). Key factors associated with significant HCRU were age, dental infection, and SCD-related complications. SCD specialized care settings and SCD intensive management strategy were reported to significantly decrease the number of hospitalizations. Conclusion This systematic evidence synthesis found that disease burden measured by PROs and economic burden of SCD on adults in the US are substantial despite the availability of approved SCD treatments during 2007–2018. The use of hydroxyurea, optimal management with opioids, and employing intensive treatment strategies may help decrease the overall burden to patients and healthcare systems. Published data on costs associated with SCD are limited and highlight the need for more economic studies to characterize the full burden of the disease.
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Affiliation(s)
- Soyon Lee
- Novartis, East Hanover, New Jersey, USA
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26
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Kayle M, Valle J, Paulukonis S, Holl JL, Tanabe P, French DD, Garg R, Liem RI, Badawy SM, Treadwell MJ. Impact of Medicaid expansion on access and healthcare among individuals with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28152. [PMID: 32147964 PMCID: PMC7096276 DOI: 10.1002/pbc.28152] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/03/2019] [Accepted: 12/13/2019] [Indexed: 11/05/2022]
Abstract
PURPOSE Sickle cell disease (SCD) is associated with high acute healthcare utilization. The purpose of this study was to examine whether Medicaid expansion in California increased Medicaid enrollment, increased hydroxyurea prescriptions filled, and decreased acute healthcare utilization in SCD. METHODS Individuals with SCD (≤65 years and enrolled in Medicaid for ≥6 total calendar months any year between 2011 and 2016) were identified in a multisource database maintained by the California Sickle Cell Data Collection Program. We describe trends and changes in Medicaid enrollment, hydroxyurea prescriptions filled, and emergency department (ED) visits and hospital admissions before (2011-2013) and after (2014-2016) Medicaid expansion in California. RESULTS The cohort included 3635 individuals. Enrollment was highest in 2014 and lowest in 2016 with a 2.8% annual decease postexpansion. Although <20% of the cohort had a hydroxyurea prescription filled, the percentage increased by 5.2% annually after 2014. The ED visit rate was highest in 2014 and decreased slightly in 2016, decreasing by 1.1% annually postexpansion. Hospital admission rates were similar during the pre- and postexpansion periods. Young adults and adults had higher ED and hospital admission rates than children and adolescents. CONCLUSIONS Medicaid expansion does not appear to have improved enrollment or acute healthcare utilization among individuals with SCD in California. Future studies should explore whether individuals with SCD transitioned to other insurance plans or became uninsured postexpansion, the underlying reasons for low hydroxyurea utilization, and the lack of effect on hospital admissions despite a modest effect on ED visits.
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Affiliation(s)
| | - Jhaqueline Valle
- Sickle Cell Data Collection Program, Tracking California/ Public Health Institute, Richmond, California
| | - Susan Paulukonis
- Sickle Cell Data Collection Program, Tracking California/ Public Health Institute, Richmond, California
| | - Jane L. Holl
- Biological Sciences Division, University of Chicago, Chicago, IL
| | | | - Dustin D. French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA,Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA,Veterans Affairs Health Services Research and Development Service, Chicago, Illinois USA
| | - Ravi Garg
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
| | - Robert I. Liem
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL,Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Sherif M. Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL,Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Marsha J. Treadwell
- University of California San Francisco Benioff Children’s Hospital, Oakland, CA
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27
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Understanding sickle cell disease: impact of surveillance and gaps in knowledge. Blood Adv 2020; 4:496-498. [PMID: 32027743 DOI: 10.1182/bloodadvances.2019001000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/20/2019] [Indexed: 01/19/2023] Open
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28
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Esham KS, Rodday AM, Smith HP, Noubary F, Weidner RA, Buchsbaum RJ, Parsons SK. Assessment of health-related quality of life among adults hospitalized with sickle cell disease vaso-occlusive crisis. Blood Adv 2020; 4:19-27. [PMID: 31891655 PMCID: PMC6960476 DOI: 10.1182/bloodadvances.2019000128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 11/25/2019] [Indexed: 01/25/2023] Open
Abstract
Sickle cell disease (SCD) is characterized by painful vaso-occlusive crises (VOCs). Self-reported pain intensity is often assessed with the Numeric Rating Scale (NRS), whereas newer patient-reported outcome measures (PROMs) assess multidimensional pain in SCD. We describe pain experiences among hospitalized adults with VOCs, using 2 PROMs: the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health and the Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me). Adults with SCD hospitalized with VOCs at 2 academic centers in Boston, Massachusetts, from April 2016 to October 2017 were eligible. Participants completed the NRS and PROMs at admission and 7 days postdischarge. PROM scores were described and compared with population norms. Length of stay (LOS) and 30-day readmission rates were assessed. Forty-two (96%) of 44 eligible patients consented and completed admission assessments. Mean age was 30.2 years (standard deviation, 9.1), 60% were women, 76% were non-Hispanic black, and 64% had hemoglobin SS. Twenty-seven participants (64%) completed postdischarge assessments. Sixty percent had ≥4 VOCs in the last year. Nearly all PROMIS Global Health and ASCQ-Me scores were worse than population norms. NRS and PROMIS Global Physical Health scores improved after discharge, the latter driven principally by improvements in pain. Overall median LOS was 7 days, and 30-day readmission rate was 40.5%. Administration of PROMs among adults with SCD hospitalized for VOCs is feasible and demonstrates participants experienced recurrent, prolonged, and severe VOCs. PROMIS Global and ASCQ-Me scores indicated substantial suffering, and the striking 30-day readmission rate highlights the vulnerability of these patients.
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Affiliation(s)
- Kimberly S Esham
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Hedy P Smith
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Farzad Noubary
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Ruth Ann Weidner
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Rachel J Buchsbaum
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA
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29
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Lubeck D, Agodoa I, Bhakta N, Danese M, Pappu K, Howard R, Gleeson M, Halperin M, Lanzkron S. Estimated Life Expectancy and Income of Patients With Sickle Cell Disease Compared With Those Without Sickle Cell Disease. JAMA Netw Open 2019; 2:e1915374. [PMID: 31730182 PMCID: PMC6902797 DOI: 10.1001/jamanetworkopen.2019.15374] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Individuals with sickle cell disease (SCD) have reduced life expectancy; however, there are limited data available on lifetime income in patients with SCD. OBJECTIVE To estimate life expectancy, quality-adjusted life expectancy, and income differences between a US cohort of patients with SCD and an age-, sex-, and race/ethnicity-matched cohort without SCD. DESIGN, SETTING, AND PARTICIPANTS Cohort simulation modeling was used to (1) build a prevalent SCD cohort and a matched non-SCD cohort, (2) identify utility weights for quality-adjusted life expectancy, (3) calculate average expected annual personal income, and (4) model life expectancy, quality-adjusted life expectancy, and lifetime incomes for SCD and matched non-SCD cohorts. Data sources included the Centers for Disease Control and Prevention, National Newborn Screening Information System, and published literature. The target population was individuals with SCD, the time horizon was lifetime, and the perspective was societal. Model data were collected from November 29, 2017, to March 21, 2018, and the analysis was performed from April 28 to December 3, 2018. MAIN OUTCOMES AND MEASURES Life expectancy, quality-adjusted life expectancy, and projected lifetime income. RESULTS The estimated prevalent population for the SCD cohort was 87 328 (95% uncertainty interval, 79 344-101 398); 998 were male and 952 were female. Projected life expectancy for the SCD cohort was 54 years vs 76 years for the matched non-SCD cohort; quality-adjusted life expectancy was 33 years vs 67 years, respectively. Projected lifetime income was $1 227 000 for an individual with SCD and $1 922 000 for a matched individual without SCD, reflecting a lost income of $695 000 owing to the 22-year difference in life expectancy. One study limitation is that the higher estimates of life expectancy yielded conservative estimates of lost life-years and income. The analysis only considered the value of lost personal income owing to premature mortality and did not consider direct medical costs or other societal costs associated with excess morbidity (eg, lost workdays for disability, time spent in the hospital). The model was most sensitive to changes in income levels and mortality rates. CONCLUSIONS AND RELEVANCE In this simulated cohort modeling study, SCD had societal consequences beyond medical costs in terms of reduced life expectancy, quality-adjusted life expectancy, and lifetime earnings. These results underscore the need for disease-modifying therapies to improve the underlying morbidity and mortality associated with SCD.
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Affiliation(s)
| | - Irene Agodoa
- Global Blood Therapeutics Inc, South San Francisco, California
| | - Nickhill Bhakta
- Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Mark Danese
- Outcomes Insights Inc, Westlake Village, California
| | - Kartik Pappu
- Global Blood Therapeutics Inc, South San Francisco, California
| | - Robin Howard
- Global Blood Therapeutics Inc, South San Francisco, California
| | | | | | - Sophie Lanzkron
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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30
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Longitudinal Trend in Emergency Department Reliance for Pain Among Sickle Cell Disease Patients in Wisconsin. J Pediatr Hematol Oncol 2019; 41:e438-e442. [PMID: 31219908 DOI: 10.1097/mph.0000000000001533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with sickle cell disease frequently visit the emergency department for pain. The metric of emergency department reliance (EDR) describes emergency department utilization in relation to all ambulatory visits and serves as a quality of care indicator. This study uses Wisconsin Medicaid data from 2011 to 2015 to examine trend of EDR for pain over the period of 5 years. We stratified our cohort (N=750) by patient ages into 4 groups: (1) children; (2) transition group; (3) young adults; and (4) adults. Using a linear mixed model, we estimated longitudinal trends adjusting for age group and hydroxyurea possession calculated as medication possession ratio. Results show that EDR for pain has distinct temporal patterns for each group. EDR for pediatrics continually remained less than the established threshold of 0.33. The EDR for transition group significantly increased over time; however, the EDR for young adults has significantly decreased since 2011. There were no significant differences in EDR over time for adults older than 30 years. Overall, increase in medication possession ratio was associated with lower EDR. The low EDR for pain among children and the improvements among adults indicate the success of efforts for sickle cell disease patients. However, further interventions are needed for the transition age group.
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31
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Johnston EE, Adesina OO, Alvarez E, Amato H, Paulukonis S, Nichols A, Chamberlain LJ, Bhatia S. Acute Care Utilization at End of Life in Sickle Cell Disease: Highlighting the Need for a Palliative Approach. J Palliat Med 2019; 23:24-32. [PMID: 31390292 DOI: 10.1089/jpm.2018.0649] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: People with sickle cell disease (SCD) have a life expectancy of <50 years, so understanding their end-of-life care is critical. Objective: We aimed to determine where individuals with SCD were dying and their patterns of care in the year preceding death to highlight end-of-life research priorities and possible opportunities for intervention. Design: Using the California SCD Data Collection Program database (containing administrative data, vital records, and Medicaid claims), we examined people with SCD who died between 2006 and 2015 (cases) at age <80 years and examined their hospital and emergency department (ED) utilization in their last year of life. Comparators included living controls with SCD matched 1:1 based on age, analysis year, insurance, and income. Results: We identified 486 people with SCD (cases) who died at a median age of 45 years (SD: 16 years). Most died in the hospital (63%) and ED (15%). In their last year of life, people with SCD were hospitalized for an average of 42 days (SD: 49 days) over five admissions. Inpatient admissions and ED visits were stable throughout the year until the month before death when acute care utilization sharply increased. In their last year of life, cases had more hospitalizations than controls, but similar ED utilization. Conclusions: People with SCD are dying acutely at a young age and most die in the hospital and the ED. Since clinicians caring for people with SCD currently cannot predict which acute events may be life-threatening, a comprehensive palliative approach to people with SCD must extend beyond chronic pain management and psychosocial support to include advance care planning.
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Affiliation(s)
- Emily E Johnston
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Oyebimpe O Adesina
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Elysia Alvarez
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, Sacramento, California
| | - Heather Amato
- Sickle Cell Data Collection Project, Tracking California, Public Health Institute, Oakland, California
| | - Susan Paulukonis
- Sickle Cell Data Collection Project, Tracking California, Public Health Institute, Oakland, California
| | - Ashley Nichols
- Division of Geriatrics, Gerontology and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lisa J Chamberlain
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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Shared Care for Adults with Sickle Cell Disease: An Analysis of Care from Eight Health Systems. J Clin Med 2019; 8:jcm8081154. [PMID: 31382365 PMCID: PMC6723540 DOI: 10.3390/jcm8081154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022] Open
Abstract
Adult sickle cell disease (SCD) patients frequently transition from pediatric hematology to adult primary care. We examined healthcare utilization for adult patients with SCD with shared care between hematologists and primary care providers (PCP). We analyzed the OneFlorida Data Trust, a centralized data repository of electronic medical record (EMR) data from eight different health systems in Florida. The number of included adults with SCD was 1147. We examined frequent hospitalizations and emergency department (ED) visits by whether the patient had shared care or single specialty care alone. Most patients were seen by a PCP only (30.4%), followed by both PCP and hematologist (27.5%), neither PCP nor hematologist (23.3%), and hematologist only (18.7%). For patients with shared care versus single specialist care other than hematologist, the shared care group had a lower likelihood of frequent hospitalizations (OR 0.63; 95% CI 0.43-0.90). Similarly, when compared to care from a hematologist only, the shared care group had a lower likelihood of frequent hospitalizations (OR 0.67; 95% CI 0.47-0.95). There was no significant relationship between shared care and ED use. When patients with SCD have both a PCP and hematologist involved in their care there is a benefit in decreased hospitalizations.
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33
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Shah N, Bhor M, Xie L, Paulose J, Yuce H. Sickle cell disease complications: Prevalence and resource utilization. PLoS One 2019; 14:e0214355. [PMID: 31276525 PMCID: PMC6611562 DOI: 10.1371/journal.pone.0214355] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/23/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives This study evaluated the prevalence rate of vaso-occlusive crisis (VOC) episodes, rates of uncomplicated and complicated VOC episodes, and the primary reasons for emergency room (ER) visits and inpatient admissions for sickle cell disease (SCD) patients. Methods The Medicaid Analytic extracts database was used to identify adult SCD patients using claims from 01JUL2009-31DEC2012. The date of the first observed SCD claim was designated as the index date. Patients were required to have continuous medical and pharmacy benefits for ≥6 months baseline and ≥12 months follow-up period. Patient demographics, baseline clinical characteristics, the rate of uncomplicated and complicated VOC (VOC with concomitant SCD complications) episodes, and reasons for ER visits and inpatient stays were analyzed descriptively. Results A total of 8,521 patients were included in the analysis, with a median age of 30 years. The average follow-up period was 2.7 years. The rate of VOC episodes anytime in the follow-up was 3.31 in person-years. During the first-year follow-up period, an average of 2.79 VOC episodes were identified per SCD patients, with 1.06 VOC episodes treated in inpatient setting and 0.90 VOC episodes in ER without admission. A total of 76,154 VOC episodes were identified during the entire follow-up period for the overall SCD patients. Most of the VOC episodes (70.3% [n = 53,523]) were uncomplicated episodes, and 29.7% were complicated episodes. Using primary diagnosis claims only, the most frequent complications during the VOC episode were infectious diseases (25.9%), fever (21.8%), and pulmonary disorders (16.2%). Among ER and hospitalizations related to VOC or SCD complication, ~85.0% had VOCs as the primary reason for admission; 15.0% had SCD complications as the primary reason. Conclusion In summary, SCD and its related comorbidities and complications result in high acute health care utilization. In addition, VOC remains the primary reason for SCD patients’ ER visits and inpatient admissions.
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Affiliation(s)
- Nirmish Shah
- Department of Medicine, Duke University, Durham, NC, United States of America
| | - Menaka Bhor
- US Oncology HEOR, Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States of America
| | - Lin Xie
- Health Economics and Outcomes Research, STATinMED Research, Ann Arbor, MI, United States of America
- * E-mail:
| | - Jincy Paulose
- US Oncology Medical, Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States of America
| | - Huseyin Yuce
- Department of Mathematics, New York City College of Technology–CUNY, New York, NY, United States of America
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34
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Sarat CNF, Ferraz MB, Ferreira Júnior MA, Corrêa Filho RAC, Souza ASD, Cardoso AIDQ, Ivo ML. Prevalência da doença falciforme em adultos com diagnóstico tardio. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Resumo Objetivo: Estimar a prevalência da doença falciforme em adultos com diagnóstico tardio, em tratamento nos ambulatórios de hematologia na rede de saúde do Estado do Mato Grosso do Sul de 2013 a 2017; descrever as características sociodemográficas; verificar associações entre os genótipos em relação a idade atual, os genótipos e a idade ao diagnóstico. Métodos: Estudo transversal, retrospectivo, com dados coletados em dois hospitais de ensino. As variáveis investigadas foram: ano do atendimento, genótipo, sexo, data de nascimento, idade ao diagnóstico, naturalidade e procedência. A prevalência foi estimada por ponto (%) e intervalo de confiança de 95%. Resultados: A prevalência foi 3,9%, com 103 adultos com doença falciforme, sendo 60 do sexo feminino e 43 do masculino. Predominou o genótipo HbSS, seguido pelo HbSC. A mediana de idade foi de 35 para os HbSS e 31 para os HbSC. A mediana de idade ao diagnóstico foi cinco anos para os HbSS e 21 para HbSC. Não houve associação entre idade (anos) dos pacientes e genótipo (teste Qui-quadrado p=0,601) e nem entre genótipo e faixa etária (teste Qui-quadrado p= 0,318). Conclusão: O genótipo mais frequente foi o HbSS, seguido pelo HbSC. O diagnóstico dos pacientes com SC foi mais tardio do que naqueles com genótipo SS. As variáveis sociodemográficas e o diagnóstico tardio alertam para a necessidade de fortalecimento de ações na rede de saúde, que interferem sensivelmente na morbimortalidade de adultos com Doença Falciforme.
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Barriteau CM, McNaull MA. Sickle Cell Disease in the Emergency Department: Complications and Management. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Linton E, Langer AL, Glassberg J. Hospital Admissions, Mortality and Comorbidities Among New York State Sickle Cell Patients, 2005-2013. J Natl Med Assoc 2017; 110:149-156. [PMID: 29580448 DOI: 10.1016/j.jnma.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/20/2017] [Accepted: 10/17/2017] [Indexed: 01/21/2023]
Abstract
Analyses of administrative and large data sources in Sickle Cell Disease (SCD) can answer questions not suitable for prospective study but have been hampered by lack of validated methods to adjust for individual comorbidities and lack of baseline utilization data over time. We sought to develop a database to characterize inpatient SCD care across New York State and generate a re-weighted sickle-cell specific Charlson Comorbidity index (S-CCI) for use in future large data SCD research. We identified 18,541 individual SCD patients admitted to New York State hospitals between 2005 and 2013 from the SPARCS database. We present data from both a randomly selected derivation cohort, used to develop the S-CCI and a validation cohort, The S-CCI resulted in small improvements in model fit and discrimination while using fewer covariates, allowing a more parsimonious model. Despite being the most common comorbidity, chronic pulmonary disease was not predictive of mortality. Mortality per hospitalization was 0.61%. Many patients (32%) were admitted only once during the nine year period. However, the majority was admitted more frequently with over 15% of patients being admitted more than once per year.
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Affiliation(s)
- Elizabeth Linton
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arielle L Langer
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Peltz A, Samuels-Kalow ME, Rodean J, Hall M, Alpern ER, Aronson PL, Berry JG, Shaw KN, Morse RB, Freedman SB, Cohen E, Simon HK, Shah SS, Katsogridakis Y, Neuman MI. Characteristics of Children Enrolled in Medicaid With High-Frequency Emergency Department Use. Pediatrics 2017; 140:peds.2017-0962. [PMID: 28765381 PMCID: PMC5574719 DOI: 10.1542/peds.2017-0962] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Some children repeatedly use the emergency department (ED) at high levels. Among Medicaid-insured children with high-frequency ED use in 1 year, we sought to describe the characteristics of children who sustain high-frequency ED use over the following 2 years. METHODS Retrospective longitudinal cohort study of 470 449 Medicaid-insured children appearing in the MarketScan Medicaid database, aged 1-16 years, with ≥1 ED discharges in 2012. Children with high ED use in 2012 (≥4 ED discharges) were followed through 2014 to identify characteristics associated with sustained high ED use (≥8 ED discharges in 2013-2014 combined). A generalized linear model was used to identify patient characteristics associated with sustained high ED use. RESULTS A total of 39 945 children (8.5%) experienced high ED use in 2012, accounting for 25% of total ED visits in 2012. Sixteen percent of these children experienced sustained high ED use in the following 2 years. Adolescents (adjusted odds ratio [aOR]: 1.4 [95% confidence interval: 1.3-1.5]), disabled children (aOR: 1.3 [95% confidence interval: 1.1-1.5]), and children with 3 or more chronic conditions (aOR: 2.1, [95% confidence interval: 1.9-2.3]) experienced the highest likelihood for sustaining high ED use. CONCLUSIONS One in 6 Medicaid-insured children with high ED use in a single year experienced sustained high levels of ED use over the next 2 years. Adolescents and individuals with multiple chronic conditions were most likely to have sustained high rates of ED use. Targeted interventions may be indicated to help reduce ED use among children at high risk.
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Affiliation(s)
- Alon Peltz
- Robert Wood Johnson Foundation Clinical Scholars Program and .,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | | | | | - Elizabeth R. Alpern
- Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Paul L. Aronson
- Section of Pediatric Emergency Medicine, Department of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Kathy N. Shaw
- Departments of Pediatrics and,Emergency Medicine, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rustin B. Morse
- Children’s Health System of Texas, and Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and,Gastroenterology, Department of Pediatrics, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Eyal Cohen
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Harold K. Simon
- Division of Emergency Medicine, Department of Pediatrics and Emergency Medicine, School of Medicine, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia; and
| | - Samir S. Shah
- Divisions of Hospital Medicine and,Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Yiannis Katsogridakis
- Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mark I. Neuman
- Emergency Medicine, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
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Identifying Social-Behavioral Health Needs of Adults with Sickle Cell Disease in the Emergency Department. J Emerg Nurs 2017; 43:444-450. [DOI: 10.1016/j.jen.2017.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/29/2017] [Accepted: 04/08/2017] [Indexed: 11/17/2022]
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