title: Age-Related Emergency Department Reliance in Patients with Sickle Cell Disease.
abstract: BACKGROUND
  Emergency Department Reliance (EDR: total emergency department [ED] visits/total ambulatory [outpatient + ED] visits) differentiates acute episodic ED users from those who may not have adequate access to outpatient care.
  
  
  OBJECTIVE
  This study's aim was to investigate age-related patterns of EDR and associated health-care costs in pediatric patients with sickle cell disease (SCD) and those transitioning from pediatric to adult care.
  
  
  METHODS
  State Medicaid data were used for this study. Patients with two or more SCD diagnoses and one or more blood transfusion were included. Quarterly rates of ED visits, EDR, SCD complications associated with ED visits, and ED visits resulting in hospitalization were evaluated. Risk factors associated with high EDR and the association between high EDR and health-care costs were explored through regression analyses.
  
  
  RESULTS
  A total of 3208 patients were included. The most common SCD complications associated with ED visits were pain, infection, and pneumonia. Beginning at the age of 15 years, EDR rose from 0.17 to 0.29 visits per quarter at age 22 years, and remained high throughout adulthood. Regression analyses indicated that patients were most likely to have high EDR during the post-transition period and when experiencing an SCD complication. Patients with high EDR incurred statistically significantly higher inpatient and ED costs, resulting in significantly higher total health-care costs.
  
  
  CONCLUSIONS
  Compared to children, patients transitioning to adulthood relied more on the ED for their care. In addition, patients with high EDR incurred more days in the hospital and significantly higher health-care costs, highlighting the need to improve transition-related support, including better access to primary care and increased engagement with patients with SCD.
authors.affiliation: Department of Medicine and Department of Pathology & Immunology, Washington University St. Louis, St. Louis, Missouri.
authors.forename: Morey A
authors.initials: MA
authors.lastname: Blinder
authors.affiliation: Analysis Group, Inc., Boston, Massachusetts.
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, New Jersey.
authors.forename: Medha
authors.initials: M
authors.lastname: Sasane
authors.affiliation: Analysis Group, Inc., Boston, Massachusetts.
authors.forename: Alex
authors.initials: A
authors.lastname: Trahey
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, New Jersey.
authors.forename: Carole
authors.initials: C
authors.lastname: Paley
authors.affiliation: Analysis Group, Inc., Montréal, Quebec, Canada.
authors.forename: Francis
authors.initials: F
authors.lastname: Vekeman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000755:Anemia, Sickle Cell / Q000150:complications / Q000191:economics / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D060305:Transition to Adult Care / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
keywords: access to care; acute care; emergency department; emergency department reliance; health-care costs; sickle cell disease; transfusion