Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
JAMA. 2010 Apr 7;303(13):1288-94. doi: 10.1001/jama.2010.378.
Published rates of health care utilization and rehospitalization by people with sickle cell disease have had limited generalizability and are not population based.
To provide benchmark data for rates of acute care utilization and rehospitalizations for patients with sickle cell disease.
Retrospective cohort of sickle cell disease-related emergency department (ED) visits and hospitalizations from select states in the 2005 and 2006 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and State Emergency Department Databases.
Eight geographically dispersed states (Arizona, California, Florida, Massachusetts, Missouri, New York, South Carolina, and Tennessee) that provide encrypted identifiers and have sufficient numbers of patients with sickle cell disease; together these states have 33% of the US population with sickle cell disease.
A total of 21,112 patients with sickle cell-related treat-and-release ED visits or inpatient hospitalizations.
Rates of acute care utilization and rehospitalizations. Population-based utilization rates were also calculated.
The 21,112 people with sickle cell disease had 109,344 encounters, a mean of 2.59 (95% confidence interval [CI], 2.53-2.65) encounters per patient per year, 1.52 (95% CI, 1.48-1.55) encounters for hospitalizations and 1.08 (95% CI, 1.04-1.11) for treat-and-release ED visits. Utilization was highest for 18- to 30-year-olds, 3.61 (95% CI, 3.47-3.75) encounters per patient per year, and those with public insurance, 3.22 (95% CI, 3.13-3.31) encounters per patient per year. Publicly insured 18- to 30-year-olds had 4.80 (95% CI, 4.58-5.02) encounters per patient per year. Approximately 29% of the population had no encounters while 16.9% had 3 or more encounters per year. The 30-day and 14-day rehospitalization rates were 33.4% (95% CI, 33.0%-33.8%) and 22.1% (95% CI, 21.8%-22.4%), respectively. The rehospitalization rate was highest for 18- to 30-year-olds, with 41.1% (95% CI, 40.5%-41.7%) rehospitalized within 30 days and 28.4% (95% CI, 27.8%-29.0%) within 14 days. Rehospitalizations were also highest for publicly insured patients.
Among patients with sickle cell disease, acute care encounters and rehospitalizations were frequent, particularly for 18- to 30-year-olds.
患有镰状细胞病的人群的医疗保健利用率和再住院率公布率具有一定的局限性，并且不具有普遍性。
为镰状细胞病患者的急性护理利用率和再住院率提供基准数据。
从 2005 年和 2006 年医疗保健成本和利用项目（HCUP）州住院数据库和州急诊部数据库中选择的 8 个地理位置分散的州（亚利桑那州、加利福尼亚州、佛罗里达州、马萨诸塞州、密苏里州、纽约州、南卡罗来纳州和田纳西州）的镰状细胞疾病相关急诊就诊和住院的回顾性队列。这些州共有 33%的镰状细胞病患者，为镰状细胞病患者提供加密标识符，并拥有足够数量的患者；这些州共有 33%的美国镰状细胞病患者。
共有 21112 例镰状细胞相关治疗后离院急诊就诊或住院患者。
急性护理利用率和再住院率。还计算了基于人群的利用率。
21112 例镰状细胞病患者共发生 109344 次就诊，平均每位患者每年有 2.59 次（95%置信区间[CI]，2.53-2.65）就诊，1.52 次（95%CI，1.48-1.55）住院就诊，1.08 次（95%CI，1.04-1.11）为治疗后离院急诊就诊。18-30 岁患者的利用率最高，每位患者每年有 3.61 次就诊（95%CI，3.47-3.75），而公共保险患者的利用率最高，每位患者每年有 3.22 次就诊（95%CI，3.13-3.31）。18-30 岁的公共保险患者每年每人有 4.80 次就诊（95%CI，4.58-5.02）。约 29%的人群没有就诊，而 16.9%的人群每年就诊 3 次或以上。30 天和 14 天的再住院率分别为 33.4%（95%CI，33.0%-33.8%）和 22.1%（95%CI，21.8%-22.4%）。18-30 岁患者的再住院率最高，其中 30 天内再住院率为 41.1%（95%CI，40.5%-41.7%），14 天内再住院率为 28.4%（95%CI，27.8%-29.0%）。公共保险患者的再住院率也最高。
在镰状细胞病患者中，急性护理就诊和再住院率很高，尤其是 18-30 岁的患者。
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