An innovative short-stay health care model for treatment of uncomplicated vaso-occlusive crisis in adult sickle cell disease patients in Canada to reduce emergency department utilization

CJEM ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Andrew Binding ◽  
Richard Ward ◽  
Chai Phua ◽  
Veronique Naessens ◽  
Tara O’Brien ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Discharge Rate ◽  
Historical Control ◽  
Secondary Outcome ◽  
Emergency Department Utilization ◽  
Short Stay ◽  
Cell Disease

AbstractObjectivesPatients with sickle cell disease (SCD) with vaso-occlusive crises (VOC) often visit the emergency department (ED) for management of painful episodes. The primary objective of this pilot study was to evaluate the acceptability of a short-stay model for treatment of VOC in SCD outside of the ED in Toronto, Canada. Secondary objectives were to assess patient satisfaction of this model, barriers to its use and comparison of clinical outcomes to a historical control.MethodsAdult SCD patients with symptoms of an uncomplicated VOC between October 2014 to July 2016 were managed according to best practice recommendations in a short-stay unit as an alternative to the local emergency room. Primary outcome of time to first analgesia, and secondary outcome of discharge rate were compared to a historical control at a local ED from 2009-2012. Satisfaction and barriers to use of the ambulatory care delivery model were assessed by patient survey.ResultsTwenty-one visits were recorded at the short-stay unit during the study period. Average time to first opiate dose was 23.5 minutes in the short-stay unit compared to 100.3 minutes in the ED (p<0.001). Discharge rate from the short-stay unit was 84.2%. Average patient satisfaction with this model of care was high (>4/5 on Likert scale) except for geographic accessibility (85% response rate, n=18).ConclusionThis study demonstrated high patient satisfaction and acceptability of a short-stay model for treatment of uncomplicated VOC in adult SCD patients in Toronto, the first of its kind in Canada.

Caregiver factors related to emergency department utilization for youth with sickle cell disease

2018 ◽  
Vol 48 (1) ◽  
pp. 59-74 ◽  
Author(s):  
Ashley Pantaleao ◽  
Joanne DiPlacido ◽  
Jessica W. Guite ◽  
William T. Zempsky
Keyword(s):  
Emergency Department ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Emergency Department Utilization ◽  
Cell Disease

scholarly journals Emergency department utilization by Californians with sickle cell disease, 2005-2014

2016 ◽  
Vol 64 (6) ◽  
pp. e26390 ◽  
Author(s):  
Susan T. Paulukonis ◽  
Lisa B. Feuchtbaum ◽  
Thomas D. Coates ◽  
Lynne D. Neumayr ◽  
Marsha J. Treadwell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Emergency Department Utilization ◽  
Cell Disease

278 Emergency Department Utilization by Californians With Sickle Cell Disease, 2005-2014

2016 ◽  
Vol 68 (4) ◽  
pp. S108
Author(s):  
S. Paulukonis ◽  
E. Vichinsky ◽  
L. Neumayr ◽  
M. Treadwell ◽  
T. Coates ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Emergency Department Utilization ◽  
Cell Disease

scholarly journals Sickle-cell disease in California: A population-based description of emergency department utilization

2010 ◽  
Vol 56 (3) ◽  
pp. 413-419 ◽  
Author(s):  
Julie A. Wolfson ◽  
Sheree M. Schrager ◽  
Thomas D. Coates ◽  
Michele D. Kipke
Keyword(s):  
Emergency Department ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Population Based ◽  
Emergency Department Utilization ◽  
Cell Disease

The California Sickle Cell Database.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1530-1530
Author(s):  
Ted Wun ◽  
Ann Brunson ◽  
Monica Brown
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Sickle Cell Disease ◽  
Longitudinal Data ◽  
Sickle Cell ◽  
Conflicts Of Interest ◽  
Health Planning ◽  
Emergency Department Utilization ◽  
Care Utilization ◽  
Cell Disease

Abstract Abstract 1530 Poster Board I-553 INTRODUCTION The Cooperative Study of Sickle Cell Disease (CSSCD) was a landmark prospective observational study that helped to define the natural history of sickle cell disease. Although this study provided (and is still yielding) a wealth of robust data, there are still gaps in knowledge on long term complications, especially in adults. In addition, the CSSCD was conducted by investigators at specialized centers, and it is possible findings might be different in a population based cohort. Therefore, we wished to use available administrative datasets to study Californians with sickle cell disease (SCD) and create a California Sickle Cell Database (CSCD). METHODS We conducted a retrospective study with which to determine complications and health care utilization amongst patients with sickle cell disease. The California Office of Statewide Health Planning and Development (OSHPD) Hospital Discharge Dataset (HDD) collects data on all hospital discharges in California (exclusive of federal facilities) since 1991. Since 2005, all non-federal emergency department (ED) visits have also been reported to the Emergency Department Utilization (EDU) system of OSHPD. Data elements include basic demographics and diagnoses. Patients can be tracked using social security numbers; therefore, longitudinal data on individual patient hospitalizations and ED utilization can be generated. The ICD-9 codes used were 282.6X. RESULTS There were 11,351 individual SCD patients identified in the OSHPD HDD (1991-2007) and EDU (2005-2007) data systems. Analysis to date has yielded some basic demographic data on utilization. Females comprised 59.3% of the cohort. As anticipated most patients (81.9%) were non-Hispanic Black. However, 7.9% were reported as non-Hispanic White and 6% as Hispanic. The majority was less than 60 years of age; however, 744 were between 60-69 years and 406 were 70-79 years of age. There were 124,455 admissions of patients with SCD from 1991 to 2007 (mean ± SD =7321 ± 473 per year). 2135 ± 168 patients per year accounted for these hospitalizations with mean hospitalizations per patient of 3.4 with SD's from 3.6 to 4.6. In the three years 2005-2007 inclusive a mean of 1,871 ± 127 patients a year utilized the ED. The mean number of ED encounters per year per patient was 5 with SD's of 13 to 22. CONCLUSIONS Limitations include those inherent with any retrospective study dependent on administrative data, including inaccurate coding. In addition, true prevalence could be underestimated due to the acquisition bias of the requirement for hospitalization and/or ED utilization to be counted. Longitudinal data may be affected by migration to other states. Nonetheless, the large number of identified cases in the CSCD will allow determination of rates for many complications of interest that commonly require hospitalization and/or ED utilization, and provide important information on the individual and societal burden of disease. Disclosures No relevant conflicts of interest to declare.

Asthma IN SICKLE CELL DISEASE as A RISK FACTOR for Acute Chest Syndrome IN Pediatric PATIENTS.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4610-4610
Author(s):  
Andrea P Borns ◽  
Kristy Marquez ◽  
Djesika Amendah ◽  
Alan Whiteman ◽  
Lanetta B Jordan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Conflicts Of Interest ◽  
Pulmonary Complications ◽  
Emergency Department Visits ◽  
Emergency Department Utilization ◽  
Acute Chest Syndrome ◽  
Cell Disease ◽  
Ann Arbor

Abstract Abstract 4610 OBJECTIVES Both asthma and sickle cell disease are major Public Health concerns. Previous studies have demonstrated that asthma among children with sickle cell disease (SCD) may increase the risk of developing acute chest syndrome (ACS), which can be life threatening. These respiratory complications may increase emergency department (ED) utilization, increase health care costs, and reduce life span among persons with SCD. The purpose of this study is to determine whether children with SCD and asthma have significantly more ED visits and if they are at higher risk of developing ACS compared to children with SCD who do not have asthma. METHODS We used MarketScan® Multi-State Medicaid Databases from Thompson Reuters (Ann Arbor, Michigan) for the years 2001 to 2005. These are proprietary datasets covering eight unidentified states. We used International Classification of Disease, 9th Division, Clinical Modifications (ICD-9-CM) codes to identify SCD, asthma and ACS. RESULTS In 2005, there were 2428 children with SCD continuously enrolled in Medicaid. Among those, 369 (15.2%) patients were identified as having asthma. The mean number of emergency department visits was significantly higher among children with both SCD and asthma compared to children with SCD without asthma (p<0.05). In addition, children with SCD and asthma were more likely to have at least one episode of ACS than children with SCD without asthma (28.2% vs. 7.8%, respectively). CONCLUSIONS Among children with SCD who are enrolled in Medicaid, asthma is a common comorbidity, which is associated with high incidence of ACS. Therefore asthma should be aggressively managed among SCD patients. Proper management of asthma may result not only in reduced pulmonary complications, but also reduced costs related to emergency department utilization and progression of lung disease into adulthood. Disclosures: No relevant conflicts of interest to declare.

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