title: Impact of proximity to comprehensive sickle cell center on utilization of healthcare services among children with sickle cell disease.
abstract: BACKGROUND
  The impact of comprehensive care on utilization of healthcare services by children with sickle cell disease (SCD) has not been fully evaluated. We compared the medical care utilization and mortality in children less than 20 years of age with SCD in four regions in the state of Tennessee with and without a comprehensive sickle cell center (CSCC).
  
  
  METHODS
  Rates of hospitalizations, outpatient and emergency department (ED) visits, and deaths were measured in a cohort of children aged <20 years with SCD, enrolled in TennCare, from January 1995 to December 2002. TennCare data linked to Tennessee vital records were used to define the population and identify the outcomes. The patients were classified into one of four regions based on their residential address on the day of their hospitalization or outpatient visit.
  
  
  RESULTS
  The cohort consisted of 1,214 children with 6,393 person-years of follow-up. Fifty-six percent of patients resided in the region with the CSCC. This region had the highest overall rates of hospitalization for all children (P < 0.001), while ED and outpatient visits were higher in other areas. The death rates ranged from 1.8 to 4.3 per 1,000 person-years in the four regions and did not represent statistically significant differences.
  
  
  CONCLUSIONS
  No clear pattern of improved utilization of medical care services were identified in relation to proximity of residence to a CSCC. This cohort was not large enough to detect small differences in death rates. In addition, other outcomes that incorporate quality of life measures may be more sensitive to differences in medical care.
authors.affiliation: Department of Pediatrics, Division of Pediatric Hematology/Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. sadhna.shankar@vanderbilt.edu
authors.forename: Sadhna M
authors.initials: SM
authors.lastname: Shankar
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Ed
authors.initials: E
authors.lastname: Mitchel
authors.forename: Hua
authors.initials: H
authors.lastname: Ding
authors.forename: Winfred C
authors.initials: WC
authors.lastname: Wang
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000755:Anemia, Sickle Cell / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D013714:Tennessee