Age-Related Emergency Department Reliance in Patients with Sickle Cell Disease.
BACKGROUND
Emergency Department Reliance (EDR: total emergency department [ED] visits/total ambulatory [outpatient + ED] visits) differentiates acute episodic ED users from those who may not have adequate access to outpatient care.


OBJECTIVE
This study's aim was to investigate age-related patterns of EDR and associated health-care costs in pediatric patients with sickle cell disease (SCD) and those transitioning from pediatric to adult care.


METHODS
State Medicaid data were used for this study. Patients with two or more SCD diagnoses and one or more blood transfusion were included. Quarterly rates of ED visits, EDR, SCD complications associated with ED visits, and ED visits resulting in hospitalization were evaluated. Risk factors associated with high EDR and the association between high EDR and health-care costs were explored through regression analyses.


RESULTS
A total of 3208 patients were included. The most common SCD complications associated with ED visits were pain, infection, and pneumonia. Beginning at the age of 15 years, EDR rose from 0.17 to 0.29 visits per quarter at age 22 years, and remained high throughout adulthood. Regression analyses indicated that patients were most likely to have high EDR during the post-transition period and when experiencing an SCD complication. Patients with high EDR incurred statistically significantly higher inpatient and ED costs, resulting in significantly higher total health-care costs.


CONCLUSIONS
Compared to children, patients transitioning to adulthood relied more on the ED for their care. In addition, patients with high EDR incurred more days in the hospital and significantly higher health-care costs, highlighting the need to improve transition-related support, including better access to primary care and increased engagement with patients with SCD.
['Blinder|Morey A|MA|', 'Duh|Mei Sheng|MS|', 'Sasane|Medha|M|', 'Trahey|Alex|A|', 'Paley|Carole|C|', 'Vekeman|Francis|F|']
D000293:Adolescent D000328:Adult D000367:Age Factors D000553:Ambulatory Care D000755:Anemia, Sickle Cell D002648:Child D002675:Child, Preschool D004636:Emergency Service, Hospital D005260:Female D017048:Health Care Costs D006760:Hospitalization D006801:Humans D007223:Infant D008297:Male D008484:Medicaid D008875:Middle Aged D012044:Regression Analysis D012307:Risk Factors D060305:Transition to Adult Care D014481:United States D055815:Young Adult
emergency department emergency department reliance sickle cell disease health-care costs transfusion access to care acute care