title: Outpatient pain predicts subsequent one-year acute health care utilization among adults with sickle cell disease.
abstract: BACKGROUND
  Patient demographic and clinical factors have known associations with acute health care utilization (AHCU) among patients with sickle cell disease (SCD), but it is unknown if pain measured predominantly in an outpatient setting is a predictor of future AHCU in patients with SCD.
  
  
  OBJECTIVE
  To determine whether multidimensional pain scores obtained predominantly in an outpatient setting predicted subsequent 1-year AHCU by 137 adults with SCD and whether the pain measured at a second visit also predicted AHCU.
  
  
  METHODS
  Pain data included the Composite Pain Index (CPI), a single score representative of a multidimensional pain experience (number of pain sites, intensity, quality, and pattern). Based on the distribution of AHCU events, we divided patients into three groups: 1) zero events (zero), 2) 1 to 3 events (low), or 3) 4 to 23 events (high).
  
  
  RESULTS
  The initial CPI scores differed significantly by the three groups (F(2,134) = 7.38, P = 0.001). Post hoc comparisons showed that the zero group had lower CPI scores than both the low (P < 0.01) and high (P < 0.001) groups. In multivariate overdispersed Poisson regression analyses, age and CPI scores (at both measurement times) were statistically significant predictors of utilization events. Pain intensity scores at both measurement times were significant predictors of utilization, but other pain scores (number of pain sites, quality, and pattern) were not.
  
  
  CONCLUSIONS
  Findings support use of outpatient CPI scores or pain intensity and age to identify at-risk young adults with SCD who are likely to benefit from improved outpatient pain management plans.
authors.affiliation: Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA; Comprehensive Sickle Cell Center, University of Illinois Hospital & Health Sciences System, Chicago, Illinois, USA.
authors.forename: Miriam O
authors.initials: MO
authors.lastname: Ezenwa
authors.affiliation: Comprehensive Sickle Cell Center, University of Illinois Hospital & Health Sciences System, Chicago, Illinois, USA; Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA; Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Jesse Brown VA Medical Center, Chicago, Illinois, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Molokie
authors.affiliation: Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Jesse Brown VA Medical Center, Chicago, Illinois, USA.
authors.forename: Zaijie Jim
authors.initials: ZJ
authors.lastname: Wang
authors.affiliation: Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA.
authors.forename: Yingwei
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA.
authors.forename: Marie L
authors.initials: ML
authors.lastname: Suarez
authors.affiliation: Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA.
authors.forename: Veronica
authors.initials: V
authors.lastname: Angulo
authors.affiliation: Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA. Electronic address: diwilkie@uic.edu.
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Wilkie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell / Q000503:physiopathology* / Q000628:therapy*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010146:Pain / Q000503:physiopathology*; D059408:Pain Management; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Composite Pain Index; Sickle cell disease; acute health care utilization; adults; gender; outpatient pain