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Hematology. 2019 Dec;24(1):189-198. doi: 10.1080/16078454.2018.1549801.

Risk factors for hospitalizations and readmissions among individuals with sickle cell disease: results of a U.S. survey study.

Author information

1
a Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , TN , USA.
2
b Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
3
c Department of Pediatrics , Vanderbilt University Medical Center , Nashville , TN , USA.
4
d Department of Hematology , St Jude Children's Research Hospital , Memphis , TN , USA.
5
e Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA.
6
f Department of Pediatrics, Division of Hematology , University of Alabama at Birmingham , Birmingham , AL , USA.
7
g Department of Hematology/Oncology , Vanderbilt University Medical Center , Nashville , TN , USA.
8
h Department of General Internal Medicine and Hematology , University of Tennessee Health Science Center , Memphis , TN , USA.
9
i Department of Pediatrics, Department of Medicine , Northwestern University , Chicago , IL , USA.
10
j Division of Hematology in Cancer and Blood Diseases Institute , University of Cincinnati , Cincinnati , OH , USA.
11
k Department of Hematology/Oncology , UCSF Benioff Children's Hospital Oakland , Oakland , CA , USA.

Abstract

OBJECTIVE:

Hospital admissions are significant events in the care of individuals with sickle cell disease (SCD) due to associated costs and potential for quality of life compromise.

METHODS:

This cross-sectional cohort study evaluated risk factors for admissions and readmissions between October 2014 and March 2016 in adults with SCD (nā€‰=ā€‰201) and caregivers of children with SCD (nā€‰=ā€‰330) at six centres across the U.S. Survey items assessed social determinants of health (e.g. educational attainment, difficulty paying bills), depressive symptoms, social support, health literacy, spirituality, missed clinic appointments, and outcomes hospital admissions and 30-day readmissions in the previous year.

RESULTS:

A majority of adults (64%) and almost half of children (reported by caregivers: 43%) were admitted, and fewer readmitted (adults: 28%; children: 9%). The most common reason for hospitalization was uncontrolled pain (admission: adults: 84%, children: 69%; readmissions: adults: 83%, children: 69%). Children were less likely to have admissions/readmissions than adults (Admissions: OR: 0.35, 95% CI: [0.23,0.52]); Readmissions: 0.23 [0.13,0.41]). For all participants, missing appointments were associated with admissions (1.66 [1.07, 2.58]) and readmissions (2.68 [1.28, 6.29]), as were depressive symptoms (admissions: 1.36 [1.16,1.59]; readmissions: 1.24 [1.04, 1.49]). In adults, difficulty paying bills was associated with more admissions, (3.11 [1.47,6.62]) readmissions (3.7 [1.76,7.79]), and higher spirituality was associated with fewer readmissions (0.39 [0.18,0.81]).

DISCUSSION:

Missing appointments was significantly associated with admissions and readmissions. Findings confirm that age, mental health, financial insecurity, spirituality, and clinic attendance are all modifiable factors that are associated with admissions and readmissions; addressing them could reduce hospitalizations.

KEYWORDS:

Health care utilization; clinic visits; health care surveys; hospital admissions; sickle cell disease; vulnerable populations

PMID:
30479187
PMCID:
PMC6349225
[Available on 2019-12-01]
DOI:
10.1080/16078454.2018.1549801
[Indexed for MEDLINE]

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