Is the medical home for adult patients with sickle cell disease a reality or an illusion?

Development of a New Adult Sickle Cell Disease Center Within an Academic Cancer Center: Impact on Hospital Utilization Patterns and Care Quality

BACKGROUND

A national shortage of specialized centers with expertise in the management of adults with sickle cell disease (SCD) remains a concerning public health disparity. Yet, there is an abundance of cancer centers whose operational infrastructure is not only suited to the treatment of the oncology patient, but also can provide medical and procedural care essential to the management of the patient with SCD. Our adult SCD center was formally embedded within an academic hospital-based cancer center in 2009. An evaluation of the impact of this new center has been performed.

METHODS

A retrospective chart review was conducted of all SCD encounters occurring 5 years pre- and post-SCD center establishment. Demographic, clinical, as well as hospital utilization and care quality data were compared.

RESULTS

The SCD population grew from 22 to 165 patients. Following establishment of the SCD center, patients experienced greater average annual outpatient preventative visits for chronic disease management (1 vs. 4.1) and fewer average hospitalizations yearly (2.4 vs. 1). There was a decrease in hospitalization rates for management of acute pain (50 vs. 23 %), average hospitalization length of stay (12 vs. 6 days), and the proportion of hospital discharges resulting in readmission within 30 days (60 vs. 40 %). Hydroxyurea use among eligible patients increased from 30 to 90 %.

CONCLUSION

Findings suggest that embedding adult SCD centers within existing cancer centers can positively impact patterns of health care utilization and improve the quality of care.