title: Outpatient follow-up and rehospitalizations for sickle cell disease patients.
abstract: BACKGROUND
  Rehospitalization rates are increasingly used as quality indicators for a variety of illnesses, including sickle cell disease. While one small, single center study suggested outpatient follow-up with a pediatric hematologist was associated with fewer rehospitalizations, no study has examined the effect of post-discharge outpatient follow-up on rehospitalization rates across ages and beyond a single site.
  
  
  METHODS
  This is a retrospective cohort study using Wisconsin Medicaid claims data for hospitalized children and adults with sickle cell disease from 2003 to 2007. The primary outcomes were rehospitalization at both 14 and 30 days after an index hospitalization for sickle cell pain crisis (ICD-9-CM codes 28242, 28262, 28264, 28269). Univariate survival analyses were performed based on outpatient visit, severe disease, asthma, and age. The Cox proportional hazards model was used for multivariate analyses yielding hazard ratios for the association between outpatient visits and subsequent rehospitalization rates.
  
  
  RESULTS
  Of the 408 patients included, 42 (10.2%) patients were rehospitalized within 14 days and 70 (17.1%) were rehospitalized within 30 days. Multivariate analysis showed that an outpatient visit is associated with lower rates of both 30-day rehospitalization (Hazard Ratio (HR) 0.442; 95%CI: 0.330-0.593) and 14-day rehospitalization (HR 0.226; 95%CI: 0.124-0.412), with the majority of 30-day rehospitalizations occurring within 14 days.
  
  
  CONCLUSIONS
  For sickle cell disease, post-discharge planning should emphasize early follow-up to prevent subsequent hospitalization and improve care quality. Pediatr Blood Cancer 2012; 58: 406-409. © 2011 Wiley Periodicals, Inc.
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI 53226, USA.
authors.forename: John
authors.initials: J
authors.lastname: Leschke
authors.forename: Julie A
authors.initials: JA
authors.lastname: Panepinto
authors.forename: Mark
authors.initials: M
authors.lastname: Nimmer
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Hoffmann
authors.forename: Ke
authors.initials: K
authors.lastname: Yan
authors.forename: David C
authors.initials: DC
authors.lastname: Brousseau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell / Q000628:therapy*; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D004630:Emergencies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014481:United States; D014922:Wisconsin