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Ericksen PN, Dabbous F, Ghosh R, Shah S, Sun X, Meier ER, Colavecchia C. Standardization of coding definitions for sickle cell disease complications: A systematic literature review. Pharmacoepidemiol Drug Saf 2024; 33:e5769. [PMID: 39205482 DOI: 10.1002/pds.5769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Sickle cell disease (SCD) affects all organ systems and is characterized by numerous acute and chronic complications and comorbidities. Standardized codes are needed for complications/comorbidities used in real-world evidence (RWE) studies that rely on administrative and medical coding. This systematic literature review was conducted to produce a comprehensive list of complications/comorbidities associated with SCD, along with their diagnosis codes used in RWE studies. METHODS A search in MEDLINE and Embase identified studies published from 2016 to 2023. Studies were included if they were conducted in US SCD populations and reported complications/comorbidities and respective International Classification of Diseases, Clinical Modification (ICD-CM) codes. All identified complications/comorbidities and codes were reviewed by a certified medical coding expert and hematologist. RESULTS Of 1851 identified studies, 39 studies were included. The most reported complications/comorbidities were stroke, acute chest syndrome, pulmonary embolism, venous thromboembolism, and vaso-occlusive crisis. Most of the studies used ICD-9-CM codes (n = 21), while some studies used ICD-10-CM codes (n = 3) or both (n = 15), depending on the study period. Most codes reported in literature were heterogeneous across complications/comorbidities. The medical coding expert and hematologist recommended modifications for several conditions. CONCLUSION While many studies we identified did not report their codes and were excluded from this review, the studies with codes exhibited diverse coding definitions. By providing a standardized set of diagnosis codes that were reported by studies and reviewed by a coding expert and hematologist, our review can serve as a foundation for accurately identifying complications/comorbidities in future research, and may reduce heterogeneity, enhance transparency, and improve reproducibility. Future efforts focused on validating these code lists are needed.
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Affiliation(s)
| | - Firas Dabbous
- Data Analytics - Real World Evidence, Evidera, Bethesda, Maryland, USA
| | - Rajrupa Ghosh
- Data Analytics - Real World Evidence, Evidera, Bethesda, Maryland, USA
| | - Surbhi Shah
- Data Analytics - Real World Evidence, Evidera, Bethesda, Maryland, USA
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Howell KE, Kayle M, Smeltzer MP, Nolan VG, Mathias JG, Nelson M, Anderson S, Porter JS, Shah N, Hankins JS. Gaps during pediatric to adult care transfer escalate acute resource utilization in sickle cell disease. Blood Adv 2024; 8:3679-3685. [PMID: 38809136 DOI: 10.1182/bloodadvances.2023011268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 05/30/2024] Open
Abstract
ABSTRACT Guidelines recommend transfer to adult health care within 6 months of completing pediatric care; however, this has not been studied in sickle cell disease (SCD). We hypothesized that longer transfer gaps are associated with increased resource utilization. Transfer gaps were defined as the time between the last pediatric and first adult visits. We estimated the association between varying transfer gaps and the rates of inpatient, emergency department (ED), and outpatient visits, using negative binomial regression. Health care utilization was evaluated in a mid-south comprehensive program for a follow-up period of up to 8 years (2012-2020) and was restricted to the first 2 years of adult health care. In total, 183 young adults (YAs) with SCD (51% male, 67% HbSS/HbSβ0-thalassemia) were transferred to adult health care between 2012 and 2018. YAs with transfer gaps ≥6 months compared with <2 months had 2.01 (95% confidence interval [CI], 1.31-3.11) times the rate of hospitalizations in the 8-year follow-up and 1.89 (95% CI, 1.17-3.04) when restricted to the first 2 years of adult health care. In the first 2 years of adult care, those with transfer gaps ≥6 months compared with <2 months, had 1.75 (95% CI, 1.10-2.80) times the rate of ED encounters. Those with gaps ≥2 to <6 months compared with <2 months had 0.71 (95 % CI, 0.53-0.95) times the rate of outpatient visits. Among YAs with SCD, a longer transfer gap was associated with increased inpatient and decreased outpatient encounters in adult health care and more ED encounters in the first 2 years of adult health care. Strategies to reduce the transfer gaps are needed.
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Affiliation(s)
- Kristen E Howell
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Matthew P Smeltzer
- Department of Epidemiology and Biostatistics, The University of Memphis, Memphis, TN
| | - Vikki G Nolan
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Joacy G Mathias
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Marquita Nelson
- Division of Hematology/Oncology, The University of Tennessee Health Science Center, Memphis, TN
| | - Sheila Anderson
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jerlym S Porter
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
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Astles R, Liu Z, Gillespie SE, Lai KW, Maillis A, Morris CR, Lane PA, Krishnamurti L, Bakshi N. Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease. Pain Rep 2023; 8:e1084. [PMID: 37559677 PMCID: PMC10409410 DOI: 10.1097/pr9.0000000000001084] [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: 08/31/2022] [Revised: 02/09/2023] [Accepted: 04/29/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction/Objective Acute pain episodes are a major cause of health care utilization (HCU) in sickle cell disease (SCD), and adolescence is associated with increased pain frequency. We sought to determine whether there were differences in acute pain trajectories by sex and frequency of pain episodes among adolescents with SCD who presented to the emergency department (ED). Methods Retrospective review of electronic health records from a large, multicampus, pediatric SCD program. Results Of the 113 adolescents included, the mean age was 16.6 (SD 0.9), 41.6% (n = 47) were female, 77.9% (n = 88) had HbSS or a similarly severe genotype, and 43.4% (n = 49) had ≥3 episodes of HCU for pain, which we defined as having history of high HCU for pain. Those with a history of high HCU for pain had higher mean pain intensity scores at presentation, were more likely to receive either intravenous or intranasal opioids, and were more likely to be hospitalized. In a model considering the 3-way interaction between sex, history of high HCU for pain, and follow-up time from the initial pain intensity score, adjusted for opioid per kilogram body weight, and prescription of hydroxyurea, adolescent female patients with high HCU for pain had the slowest decline in pain intensity during treatment for acute pain in the ED. Conclusion Sex and history of high HCU for pain are associated with acute pain trajectories in adolescents with SCD presenting to the ED. These novel findings should be confirmed in future prospective studies.
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Affiliation(s)
- Rachel Astles
- Emory University School of Medicine, Atlanta, GA, USA
| | - Zihao Liu
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Scott E. Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Kristina W. Lai
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Alexander Maillis
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Nitya Bakshi
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Osunkwo I, Lawrence R, Robinson M, Patterson C, Symanowski J, Minniti C, Bryant P, Williams J, Eckman J, Desai P. Sickle Cell Trevor Thompson Transition Project (ST3P-UP) protocol for managing care transitions: Methods and rationale. Contemp Clin Trials 2023; 126:107089. [PMID: 36669729 DOI: 10.1016/j.cct.2023.107089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Emerging adults with sickle cell disease (EASCD) experience significant challenges transitioning from pediatric to adult care. Acute care utilization increases, quality of life (QOL) declines, with an increased risk of mortality. Currently, there are no practice standards to guide emerging adults through the transition process. We are creating a structured transition education (STE) based program for EASCD by customizing the Six Core Elements (6 CE) of Health Care Transition model and are evaluating the effectiveness of adding peer mentoring (PM). METHODS The Sickle Cell Trevor Thompson Transition Project (ST3P-UP) is an ongoing multi-site, cluster randomized clinical trial with a target enrollment of 537 EASCD aged 16 to 25 years in pediatric care. Each site (n = 14) comprises a pediatric clinic, adult clinic, and a sickle cell disease (SCD) community-based organization (CBO). Sites are randomized 1:1 to either STE or STE + PM. EASCDs are followed prospectively for 24 months. Rapid cycle plan-do-study-act quality improvement (QI) methods are used to implement the STE. The primary objective is to compare the effectiveness of STE + PM versus STE only at decreasing the number of acute care visits per year over 24 months. The secondary objectives are to compare overall healthcare utilization and patient-reported QOL outcomes at 24 months. CONCLUSION We aim to demonstrate the feasibility of using a QI approach to implement 6 CE-based practice standards at 14 disparate SCD clinical programs to guide EASCD through the transition process. We hypothesize that adding PM to the STE program will improve acute care reliance, QOL, and satisfaction with transition outcomes.
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Affiliation(s)
- Ifeyinwa Osunkwo
- Sickle Cell Disease Enterprise, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Raymona Lawrence
- Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, United States of America.
| | - Myra Robinson
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Charity Patterson
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - James Symanowski
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Caterina Minniti
- Department of Hematology, Adult Comprehensive Sickle Cell Program Montefiore Medical Center, Bronx, NY, United States of America
| | - Paulette Bryant
- St. Jude's Affiliate Clinic, Hemby Children's Hospital, Novant Health, Charlotte, NC, United States of America
| | - Justina Williams
- Piedmont Health Services and Sickle Cell Agency, Greensboro, NC, United States of America
| | - James Eckman
- Emory University, Atlanta, GA, United States of America
| | - Payal Desai
- Sickle Cell Disease Enterprise, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
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Schlenz AM, Thomas SJ, Gloston G, Lebensburger J, Maxwell SL, Kanter J. Sleep quality and pain in adolescents and young adults with sickle cell disease. J Clin Sleep Med 2022; 18:2845-2853. [PMID: 35975556 PMCID: PMC9713903 DOI: 10.5664/jcsm.10240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES This study evaluated sleep quality in relation to pain and pain-related impairment in adolescents and young adults with sickle cell disease. The purpose was to examine whether increased age was associated with poorer sleep quality and pain and to examine the sleep quality-pain association in this age group. METHODS Eighty-nine adolescents and young adults with sickle cell disease between the ages of 13 and 25 completed ratings of sleep quality, overall pain, and 2 measures of pain-related impairment (pain impact and pain burden) as part of their clinical care. Retrospective chart reviews were completed to match ratings to demographic and medical characteristics. Correlations and multiple regression were used to examine associations between age, sleep quality, and pain variables, including an exploratory analysis of the sleep-pain association by age. RESULTS Increased age was associated with poorer sleep quality, worse overall pain, and higher pain burden. Poorer sleep quality was also associated with worse overall pain and pain burden. Using multiple regression, a small, but not statistically significant trend was observed for the interaction of increased age and strengthening of the sleep quality-pain burden association. CONCLUSIONS Sleep quality and pain are important challenges for adolescents and young adults with sickle cell disease that may persist or worsen with increased age. Early identification of these difficulties in pediatric populations as well as continued screening and intervention as adolescents transition into adult care is important. Additional longitudinal research is needed to better understand the progression of the sleep-pain relationship over time. CITATION Schlenz AM, Thomas SJ, Gloston G, Lebensburger J, Maxwell SL, Kanter J. Sleep quality and pain in adolescents and young adults with sickle cell disease. J Clin Sleep Med. 2022;18(12):2845-2853.
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Affiliation(s)
- Alyssa M. Schlenz
- Department of Pediatrics, Medical University of South Carolina, Columbia, South Carolina
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - S. Justin Thomas
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabrielle Gloston
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey Lebensburger
- Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sarah L. Maxwell
- Department of Pediatrics, Medical University of South Carolina, Columbia, South Carolina
- Department of Pediatrics, Division of Gastroenterology, University of California, San Francisco, California
| | - Julie Kanter
- Department of Medicine, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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Heyman HM, Alberts NM, Rees M, Puri L, Frett MJ, Anghelescu DL. COVID-19 infection and pain in adolescents with sickle cell disease: A case series. EJHAEM 2022; 3:1310-1315. [PMID: 36467817 PMCID: PMC9713040 DOI: 10.1002/jha2.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 06/17/2023]
Abstract
Adolescents with sickle cell disease (SCD) have been shown to have pain-related sequelae following COVID-19 infection. In this case series, we discuss five adolescents with SCD and SARS-CoV-2 infection who subsequently developed complex pain circumstances manifested as: (1) increased frequency of acute care visits or admissions for pain; (2) new onset chronic pain; (3) new onset neuropathic pain; (4) escalation in the complexity of pharmacologic therapies; (5) increased use of nonpharmacologic interventions. While more research is needed to fully understand the implications of COVID-19 infection on pain in adolescents with SCD, these cases suggest the presence of a complex relationship.
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Affiliation(s)
- Heidi M. Heyman
- Department of Pediatric MedicineDivision of AnesthesiologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Matthew Rees
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Latika Puri
- Department of HematologyLoma Linda UniversityLoma LindaCaliforniaUSA
| | - Michael J. Frett
- Department of Pediatric MedicineDivision of AnesthesiologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Doralina L. Anghelescu
- Department of Pediatric MedicineDivision of AnesthesiologySt. Jude Children's Research HospitalMemphisTennesseeUSA
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Agawu A, Shults J, Smith-Whitley K, Feudtner C. Age- and sex-specific rates of gall bladder disease in children with sickle cell disease. Pediatr Blood Cancer 2022; 69:e29863. [PMID: 35997530 DOI: 10.1002/pbc.29863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/28/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) have an increased risk for gallstones due to chronic hyperbilirubinemia from hemolysis. Although gallstones are a known complication, there is variability in estimates of disease burden and uncertainty in the association between sex and gall bladder disease (GBD). METHODS This was a retrospective cohort study of children with SCD using administrative claims data (January 1, 2014-December 31, 2018). Population-averaged multivariable panel-data logistic regression models were used to evaluate the association between GBD clinical encounters (outcome) and two exposures (age and sex). Annual GBD risk was calculated using predictive margins, adjusting for disease severity, transfusion frequency, and hydroxyurea exposure. RESULTS A total of 13,745 individuals (of 21,487 possible) met inclusion criteria. The population was evenly split across sex (49.5% female) with predominantly Medicaid insurance (69%). A total of 946 individuals (6.9%) had GBD, 432 (3.1%) had a gallstone complication, and 487 (3.5%) underwent cholecystectomy. The annual risk of GBD rose nonlinearly from 1 to 5% between ages 1 and 19 years with no difference between males and females. Cholecystectomy occurred primarily in individuals with GBD (87%), and neither age nor sex was associated with cholecystectomy in this population. High disease severity (compared with low) more than doubled the annual risk of GBD at all ages. CONCLUSIONS GBD is associated with age but not sex in children with SCD. Neither age nor sex is associated with risk of cholecystectomy. High disease severity increases the rate of GBD at all ages.
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Affiliation(s)
- Atu Agawu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania, USA.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
| | - Justine Shults
- Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, USA
| | - Kim Smith-Whitley
- Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA.,Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Manwani D, Burnett AL, Paulose J, Yen GP, Burton T, Anderson A, Wang S, Lee S, Saraf SL. Treatment patterns and burden of complications associated with sickle cell disease: A US retrospective claims analysis. EJHAEM 2022; 3:1135-1144. [PMID: 36467832 PMCID: PMC9713207 DOI: 10.1002/jha2.575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 06/17/2023]
Abstract
Complications associated with sickle cell disease (SCD) that are highly impactful for patients but until recently have been less understood include priapism, nephropathy, and neurologic injury. We conducted a retrospective study using US administrative claims data from July 01, 2013 through March 31, 2020 to analyze incidence of these complications, SCD treatment patterns, and healthcare resource utilization (HCRU) and costs among 2524 pediatric and adult patients with SCD (mean [SD] age 43.4 [22.4] years). The most common treatments during follow-up were short-acting opioids (54.0% of patients), red blood cell transfusion (15.9%), and hydroxyurea (11.0%). SCD complications occurred frequently; in the overall population, the highest follow-up incidences per 1000 person-years were for acute kidney injury (53.1), chronic kidney disease (40.6), and stroke (39.0). Complications occurred across all age groups but increased in frequency with age; notably, acute kidney injury was 69.7 times more frequent among ages 65+ than ages 0-15 (p < 0.001). Follow-up per-patient-per-month HCRU also increased with age; however, all-cause healthcare costs were similarly high for all age groups and were driven primarily by inpatient stays. Patients with SCD across the age spectrum have a high burden of complications with the use of current treatments, suggesting unmet needs for treatment management.
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Affiliation(s)
- Deepa Manwani
- Albert Einstein College of MedicineThe Children's Hospital at MontefioreThe BronxNew YorkUSA
| | - Arthur L. Burnett
- Department of UrologyThe Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jincy Paulose
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | - Glorian P. Yen
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | | | | | - Sara Wang
- Optum Life SciencesEden PrairieMinnesotaUSA
| | - Soyon Lee
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | - Santosh L. Saraf
- Sickle Cell CenterDivision of Hematology and OncologyUniversity of Illinois Hospital and Health Sciences SystemChicagoIllinoisUSA
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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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10
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Mennito S, Martin T. Growing Up With Sickle Cell Disease: Hospital Medicine and Health Care Transitions. Hosp Pediatr 2021; 11:hpeds.2021-006358. [PMID: 34807971 DOI: 10.1542/hpeds.2021-006358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Temeia Martin
- Internal Medicine
- Psychiatry, Medical University of South Carolina, Charleston, South Carolina
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Iliyasu Z, Borodo AM, Jibir BW, Nass NS, Aliyu MH. " A child with sickle cell disease can't live with just anyone." A mixed methods study of socio-behavioral influences and severity of sickle cell disease in northern Nigeria. Health Sci Rep 2021; 4:e222. [PMID: 33376812 PMCID: PMC7757738 DOI: 10.1002/hsr2.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/11/2020] [Accepted: 11/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The modulatory effects of psychosocial and biophysical environments on sickle cell disease (SCD) severity during childhood has not been well characterized in high burden settings, such as Nigeria. OBJECTIVES We identified socio-demographic correlates and explored caregivers' perceptions on socio-behavioral and environmental influences on hospitalization for pain and blood transfusion of children with SCD in Kano, Nigeria. METHODS Using mixed methods, structured questionnaires were administered to a clinic-based sample of caregivers of children with SCD (n = 372), complemented with eight focus group discussions. Binary logistic regression models and the framework approach were used to analyze the data. RESULTS The majority (73.1%, n = 272) of the children had at least one vaso-occlusive crisis (VOC), and 41.1% (n = 153) required hospitalization in the preceding year. A total of 170 children (45.7%) received blood transfusion. Hospitalization was predicted by the child's age (Adjusted Odds Ratio, AOR = 1.89; 95% Confidence Interval, CI: 1.18-4.07, ≥10 vs <5 years), relationship with caregiver (AOR = 5.41; 95%CI: 1.17-25.05, mother vs "others"), father's number of children (AOR = 2.21; 95%CI: 1.19-5.31, ≥10 vs ≤4), and siblings with SCD (AOR = 2.36; 95%CI: 1.16-8.80, 2 vs 0). Caregivers perceived maternal care, stable home environment, medication adherence, anti-mosquito measures, and adequate nutrition as protective factors, whereas poverty, extreme emotions, physical exertion, and extreme temperatures were identified as detrimental to the health of the child. CONCLUSIONS Hospitalizations for VOC and transfusion rates among children with SCD were high. Understanding the modulatory effects of socio-behavioral factors on SCD severity could inform preventive measures and enhance the quality of life of affected children.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community MedicineBayero UniversityKanoNigeria
| | - Awwal M. Borodo
- Department of MedicineMurtala Mohammed Specialist HospitalKanoNigeria
| | - Binta W. Jibir
- Department of PediatricsMurtala Mohammed Specialist Hospital & Hasiya Bayero Pediatric HospitalKanoNigeria
| | - Nafisa S. Nass
- Department of Community MedicineBayero UniversityKanoNigeria
| | - Muktar H. Aliyu
- Department of Health Policy and Vanderbilt Institute for Global HealthVanderbilt University Medical CenterNashvilleTennessee
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