title: Factors influencing utilization of hospital services by adult sickle cell disease patients: a systematic review.
abstract: Painful vaso-occlusive crisis is a hallmark of sickle cell disease (SCD) that commonly results in utilization of hospital services. Recurrent use of hospital services by SCD patients is associated with high healthcare costs and adverse clinical outcomes. Understanding the factors influencing the pattern of utilization is a first step in improving medical care of this patient population while reducing healthcare expenditures.
  
  
  
  The primary objective of this systematic review was to determine what modifiable and non-modifiable factors influence utilization of hospital services by adult SCD patients.
  
  
  
  Adult SCD patients of both sexes who utilized hospital services for acute or emergency care.
  
  
  
  Non-modifiable and modifiable factors influencing utilization of hospital services.
  
  
  
  Prospective and retrospective cohort studies, case-control and analytical cross-sectional studies.
  
  
  
  The primary outcome of interest was high utilization of hospital services by adult SCD patients based on non-modifiable and modifiable factors measured as an odds ratio (analytical outcome). The secondary outcome was the prevalence of non-modifiable and modifiable factors among SCD patients who utilized hospital services measured as an event rate (descriptive outcome).
  
  
  
  A comprehensive multi-step search was undertaken to find both published and unpublished studies. Only studies published in the English language were included. The search was not limited by year of publication.
  
  
  
  Retrieved papers were assessed for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument.
  
  
  
  Data were extracted using a researcher-developed tool.
  
  
  
  Included studies were combined in a statistical meta-analysis. The meta-analysis was based on a random effect model. For studies that did not allow statistical pooling, the findings have been presented in a narrative form.
  
  
  
  Fourteen studies were included in this review. The analysis demonstrated that male patients accounted for 40.8% (95% confidence interval [CI] 0.370-0.447) of all utilizing patients. Sickle cell disease patients who were publically insured accounted for 76.5% (95% CI 0.632-0.861) of all patients who had hospital encounters. Patients aged 25-35 years had the highest rate of utilization, and the rate of utilization declined in patients older than 50 years. High utilizing patients had more diagnoses of acute chest syndrome and sepsis than patients who were moderate or low utilizers.
  
  
  
  The majority of SCD patients who utilized hospital services were women, young people and publically insured individuals. Patients with particularly high level of utilization had more frequent diagnoses of acute chest syndrome and sepsis.
authors.affiliation: 1School of Nursing, Rutgers University, Newark, USA 2The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence 3Division of Nursing Science, School of Nursing, Rutgers University, Newark, USA 4Department of Quantitative Methods, Epidemiology and Biostatistics, School of Public Health, Rutgers University, Newark, USA 5Division of Advanced Nursing Practice, School of Nursing, Rutgers University, Newark, USA.
authors.forename: Irina
authors.initials: I
authors.lastname: Benenson
authors.forename: Yuri
authors.initials: Y
authors.lastname: Jadotte
authors.forename: Mercedes
authors.initials: M
authors.lastname: Echevarria
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D012307:Risk Factors