title: Concentration of hospital care for acute sickle cell disease-related visits.
abstract: BACKGROUND
  Sickle cell disease (SCD) is characterized by frequent disease-related events that require acute care. It is unknown to what extent patients utilize multiple hospitals for acute care. We examined the continuity pattern of acute care visits to the hospital or emergency department. We hypothesized that among patients with multiple SCD related acute care visits, children experience more concentrated hospital care than adults and privately insured patients experience more concentrated hospital care than publicly insured patients.
  
  
  METHODS
  We conducted a retrospective cohort study using data from the 2005 and 2006 Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases. Subjects included patients with SCD ≥ 1 year of age. The primary outcome was proportion of patients with multiple acute care visits to a single hospital.
  
  
  RESULTS
  A total of 13,533 patients made ≥ 2 acute SCD-related visits. Of the 5,030 children, 77.3% went to the same hospital for all visits. In contrast, of the 8,503 adults, only 51.3% visited the same hospital. Adolescents were more likely than adults to go to one hospital [adjusted relative risk (ARR) 1.40, confidence interval (CI) 1.35-1.45]. Those with public insurance and the uninsured had a decreased probability of using one hospital (ARR 0.96, CI 0.94-0.99, and ARR 0.83, CI 0.79-0.88, respectively).
  
  
  CONCLUSIONS
  Adults and patients with public insurance or no insurance are more likely to use multiple hospitals for acute care. By receiving acute care at multiple hospitals, patients with SCD experience dispersed and fragmented care potentially leading to decreased care quality.
authors.affiliation: Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. jpanepin@mcw.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Panepinto
authors.forename: P L
authors.initials: PL
authors.lastname: Owens
authors.forename: A L
authors.initials: AL
authors.lastname: Mosso
authors.forename: C A
authors.initials: CA
authors.lastname: Steiner
authors.forename: D C
authors.initials: DC
authors.lastname: Brousseau
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D014481:United States; D055815:Young Adult