title: Intensive management of high-utilizing adults with sickle cell disease lowers admissions.
abstract: A minority of super-utilizing adults with sickle cell disease (SCD) account for a disproportionate number of emergency department (ED) and hospital admissions. We performed a retrospective cohort study comparing the rate of admission before and after the opening of a clinic for adults with SCD. Unique to this clinic was an intensive management strategy, focusing on super-utilizing adults with 12 or more admissions per year. ED/hospital and 30 days re-admission rates were compared, 1 year pre- and post-intervention, for those adults who established in the clinic. Prior to the intervention, 17 super-utilizers, comprising 15% of the pre-intervention cohort (n = 115), accounted for 58% of the total admissions and had an admission rate of 28 per patient-year. When pre- and post-intervention years were compared, rate of ED/hospital admission per patient-year for super-utilizers decreased from 27.9 to 13.5 (P < 0.001), while there was not a significant reduction for the entire cohort (7.1 vs. 6.1, P = 0.84). Similarly, the decrease in rate of 30 day re-admission was larger for the super-utilizers (13.5 per patient-year to 1.8, P < 0.001), than the whole cohort (2.6 per patient-year to 0.7, P = 0.006). Among the super-utilizers, the reduced rate of admission from the pre- to post-clinic intervention year equated to 252 fewer ED/hospital admissions and 227 fewer 30 day re-admissions. This management strategy focusing on super-utilizing adults with SCD lowered admission and 30 day re-admission rate.
authors.affiliation: Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Koch
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Karafin
authors.forename: Pippa
authors.initials: P
authors.lastname: Simpson
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Field
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000628:therapy*; D000986:Antisickling Agents / Q000627:therapeutic use*; D001803:Blood Transfusion; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D000986:Antisickling Agents; D006918:Hydroxyurea