title: Sickle-cell disease in California: a population-based description of emergency department utilization.
abstract: BACKGROUND
  Acute and chronic clinical manifestations of sickle-cell disease (SCD) lead to significant healthcare utilization, especially of the emergency department (ED). Limited population-level data are available in SCD with the ability to connect patients to visits, leaving us with minimal description of utilization patterns.
  
  
  METHODS
  Using ED discharge data with links between patients and visits, we sought to describe the California SCD population and its ED utilization patterns across facilities. Non-public California Office of Statewide Health Planning and Development data employ unique patient identifiers, linking patients, and visits.
  
  
  RESULTS
  SCD patients of all ages are heavily reliant on Medicaid (46%). The majority of SCD Californians visit an ED more than once during a year (69%), but only a minority use more than one facility during a year (34%). However, adults with SCD have multiple visits and utilize multiple EDs in higher proportions than do children (72% vs. 60% and 40% vs. 21%, respectively). A higher proportion of visits to the ED are made by SCD adults, but a higher proportion of visits by children result in hospital admission. Uninsured adults outnumber uninsured children (16% vs. 5%).
  
  
  CONCLUSIONS
  ED utilization by the California SCD population is described on a population level. Utilization patterns by adults point towards increased utilization in the population no longer eligible for Title V pediatric coverage for their disease. Further investigation using population-level socioeconomic and geographic correlates is warranted to evaluate the factors leading to ED utilization in SCD.
authors.affiliation: Division of Pediatric Hematology-Oncology, Childrens Hospital Los Angeles, Los Angeles, CA, USA. jwolfson@coh.org
authors.forename: Julie A
authors.initials: JA
authors.lastname: Wolfson
authors.forename: Sheree M
authors.initials: SM
authors.lastname: Schrager
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Coates
authors.forename: Michele D
authors.initials: MD
authors.lastname: Kipke
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000453:epidemiology* / Q000517:prevention & control*; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D055815:Young Adult