Did the universal zero-markup drug policy lower healthcare expenditures? Evidence from Changde, China

Abstract Background The zero-markup drug policy (also known as the universal zero-markup drug policy (UZMDP)) was implemented in stages beginning with primary healthcare facilities in 2009 and eventually encompassing city public hospitals in 2016. This policy has been a central pillar of Chinese health reforms. While the literature has examined the impacts of this policy on healthcare utilization and expenditures, a more comprehensive and detailed assessment is warranted. The purpose of this paper is to explore the impacts of the UZMDP on inpatient and outpatient visits as well as on both aggregate healthcare expenditures and its various components (including drug, diagnosis, laboratory, and medical consumables expenditures). Methods A pre-post design was applied to a dataset extracted from the Changde Municipal Human Resource and Social Security Bureau comprising discharge data on 27,246 inpatients and encounter data on 48,282 outpatients in Changde city, Hunan province, China. The pre-UZMDP period for the city public hospitals was defined as the period from October 2015 to September 2016, while the post-UZMDP period was defined as the period from October 2016 to September 2017. Difference-in-Difference negative binomial and Tobit regression models were employed to evaluate the impacts of the UZMDP on healthcare utilization and expenditures, respectively. Results Four key findings flow from our assessment of the impacts of the UZMDP: first, outpatient and inpatient visits increased by 8.89 % and 9.39 %, respectively; second, average annual inpatient and outpatient drug expenditures fell by 4,349.00 CNY and 1,262.00 CNY, respectively; third, average annual expenditures on other categories of healthcare expenditures increased by 2,500.83 CNY, 417.10 CNY, 122.98 CNY, and 143.50 CNY for aggregate inpatient, inpatient diagnosis, inpatient laboratory, and outpatient medical consumables expenditures, respectively; and fourth, men and older individuals tended to have more inpatient and outpatient visits than their counterparts. Conclusions Although the UZMDP was effective in reducing both inpatient and outpatient drug expenditures, it led to a sharp rise in other expenditure categories. Policy decision makers are advised to undertake efforts to contain the growth in total healthcare expenditures, in general, as well as to evaluate the offsetting effects of the policy on non-drug components of care.

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Impact of the zero-mark-up drug policy on drug-related expenditures and use in public hospitals, 2016–2018: an interrupted time series study in Shaanxi

BMJ Open ◽

10.1136/bmjopen-2020-037034 ◽

2020 ◽

Vol 10 (11) ◽

pp. e037034

Author(s):

Kangkang Yan ◽

Caijun Yang ◽

Hongli Zhang ◽

Dan Ye ◽

Shengyuan Liu ◽

...

Keyword(s):

Time Series ◽

Drug Policy ◽

Interrupted Time Series ◽

Public Hospitals ◽

Medical Expenditures ◽

Shaanxi Province ◽

Increasing Trend ◽

Tertiary Hospitals ◽

Drug Expenditures ◽

Outpatient Drug

ObjectiveThe aim of this study was to measure the impact of zero-mark-up drug policy (ZMDP) on drug-related expenditures and use in urban hospitals.DesignThis was a retrospective observational study of trends in drug expenses and use in the context of the ZMDP using an interrupted time series analysis.SettingTwelve hospitals (three tertiary hospitals and nine secondary hospitals) in Xi’an, which is the capital of Shaanxi Province in Western China.Data and participantsThe prescription information for all outpatients and inpatients in the study hospitals from January 2016 to April 2018 was used in this study.InterventionsThe Chinese government announced the policy intervention measure of the ZMDP, which was implemented in all public hospitals as of 1 April 2017.Primary measuresMonthly drug expenditures, monthly medical expenditures, the percentage of drug expenditures among total medical expenditures, the average outpatient drug expenditure per visit, the percentage of prescriptions that include an injection and the percentage of prescriptions that include an antibiotic.ResultsMonthly total medical expenses increased in both tertiary and secondary hospitals after the ZMDP was implemented. In tertiary hospitals, the average outpatient drug expenditures per visit showed a slow decreasing trend before the intervention and an increasing trend after the intervention, with statistically significant changes in both the level (p<0.001) and the trend (p=0.02). Secondary hospitals showed a slow increasing trend both before and after the policy implementation, with no significant change in the trend (p=0.205). The proportion of prescriptions, including injections, was over 20% in secondary hospitals and less than 20% in tertiary hospitals, with no significant changes to this indicator observed after implementation of ZMDP.ConclusionsThe effect of the ZMDP on drug-related expenditures and use in Chinese public hospitals was not substantially evident. Future pharmaceutical reform measures should give more consideration to physician prescription behaviours.

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Incidence of Medical Malpractice Lawsuits and Its Relationship to the Growth of Private Hospitals

10.21203/rs.3.rs-78223/v1 ◽

2020 ◽

Author(s):

Yu Sun ◽

Gordon G. Liu ◽

Mengxiao Wang ◽

Sijia Liu

Keyword(s):

Health Care ◽

Medical Malpractice ◽

Fixed Effects ◽

Negative Binomial ◽

Public Hospitals ◽

Health Care Market ◽

Private Hospitals ◽

Outpatient Visits ◽

Province Level ◽

Health Statistic

Abstract BackgroundDoctor-patient relationship has become an intense concern in public health in recent years. Medical malpractice lawsuits have presented an increasing trend over past decade. This study aims to describe distributions of medical malpractice lawsuits across different provinces and to investigate its relationship to the growth of private hospitals.MethodsData was drawn from China Judgments Online, the China Health Statistic Yearbooks and China Statistical Yearbooks between January 1, 2010 to December 31, 2016. Private hospitals expansion was measured by the number and proportion of private hospitals, the ratio of outpatient visits from private to public hospitals and the ratio of discharges from private to public hospitals. Fixed-effects negative binomial regressions were utilized to estimate the association between the growth of private hospitals and the number of medical malpractice lawsuits.ResultsIn total, we identified a total of 18220 lawsuits relevant to medical malpractices across China between 2010 and 2016. The regression results revealed that more private hospitals, larger proportion of private hospitals and higher ratio of discharges from private to public hospitals were significantly associated with fewer medical malpractice lawsuits. An increase of 100 private hospitals in health care market was associated with a decrease in the number of medical malpractice lawsuits by 21%. The ratio of outpatient visits from private to public hospitals was not significantly associated with the number of malpractice lawsuits. ConclusionsThere was great disparities of incidences of medical malpractice lawsuits across different provinces. Greater expansion of private hospitals was associated with fewer medical malpractice lawsuits at province level. This negative association indicated that more private hospitals in health care market might provide more incentives for hospitals to contain the incidences of medical malpractice cases.

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Regional Prevalence of Dyslipidemia, Healthcare Utilization, and Cardiovascular Disease Risk in South Korean: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020538 ◽

2021 ◽

Vol 18 (2) ◽

pp. 538

Author(s):

Kyu-Tae Han ◽

SeungJu Kim

Keyword(s):

Healthcare Utilization ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Estimating Equation ◽

High Density ◽

Public Health Issue ◽

Cvd Risk ◽

Healthcare Expenditures ◽

South Korean ◽

Outpatient Visits

Background: Health disparities between different populations have long been recognized as a problem, and they are still an unsolved public health issue. Many factors can make a difference, and disparities for cardiovascular diseases (CVDs) are especially pronounced. This study aimed to assess South Korean regional variations for dyslipidemia prevalence, differences in healthcare utilization, and CVD risk. Methods: We used data from 52,377 patients from the National Health Insurance Sampling. Outcome variables were the risk of CVD, healthcare utilization (outpatient visits), and healthcare expenditures. A generalized estimating equation model was used to identify associations between the region and CVD risk, a Poisson regression model was used for evaluating outpatient visits, and a generalized linear model (gamma and log link function) was used to evaluate healthcare expenditures. Results: A total of 12,443 (23.8%) patients were diagnosed with CVD. Dyslipidemia prevalence varied by region, and the most frequent dyslipidemia factor was high total cholesterol. CVD risk was increased in low population-density regions compared to high-density regions (odds ratio [OR]: 1.133, 95% confidence interval [CI]: 1.037–1.238). Healthcare expenditures and outpatient visits were also higher in low-density regions compared to high-density regions. Conclusions: This study provides a regional assessment of dyslipidemia prevalence, healthcare utilization, and CVD risk. To bridge differences across regions, consideration should be given not only to general socio-economic factors but also to specific regional factors that can affect these differences, and a region-based approach should be considered for reducing disparities in general health and healthcare quality.

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An analysis of medical malpractice lawsuits and its relationship to the growth of private hospitals

10.21203/rs.3.rs-63474/v1 ◽

2020 ◽

Author(s):

Yu Sun ◽

Gordon G. Liu ◽

Mengxiao Wang ◽

Sijia Liu

Keyword(s):

Health Care ◽

Medical Malpractice ◽

Fixed Effects ◽

Negative Binomial ◽

Public Hospitals ◽

Health Care Market ◽

Private Hospitals ◽

Outpatient Visits ◽

Province Level ◽

Health Statistic

Abstract Background Doctor-patient relationship has become an intense concern in public health in recent years. Medical malpractice lawsuits have presented an increasing trend over past decade. This study aims to describe distributions of medical malpractice lawsuits across different provinces and to investigate its relationship to the growth of private hospitals.Methods Data was drawn from China Judgments Online, the China Health Statistic Yearbooks and China Statistical Yearbooks between January 1, 2010 to December 31, 2016. Private hospitals expansion was measured by the number and proportion of private hospitals, the ratio of outpatient visits from private to public hospitals and the ratio of discharges from private to public hospitals. Fixed-effects negative binomial regressions were utilized to estimate the association between the growth of private hospitals and the number of medical malpractice lawsuits.Results In total, we identified a total of 18220 lawsuits relevant to medical malpractices across China between 2010 and 2016. The regression results revealed that more private hospitals, larger proportion of private hospitals and higher ratio of discharges from private to public hospitals were significantly associated with fewer medical malpractice lawsuits. An increase of 100 private hospitals in health care market was associated with a decrease in the number of medical malpractice lawsuits by 21%. The ratio of outpatient visits from private to public hospitals was not significantly associated with the number of malpractice lawsuits.Conclusions There was great disparities of incidences of medical malpractice lawsuits across different provinces. Greater expansion of private hospitals was associated with fewer medical malpractice lawsuits at province level. This negative association indicated that more private hospitals in health care market might provide more incentives for hospitals to contain the incidences of medical malpractice cases.

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Modeling count data for health care utilization: an empirical study of outpatient visits among Vietnamese older people

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01619-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Duc Dung Le ◽

Roberto Leon Gonzalez ◽

Joseph Upile Matola

Keyword(s):

Model Selection ◽

Older People ◽

Healthcare Utilization ◽

Count Data ◽

Cross Validation ◽

Negative Binomial ◽

Outpatient Visits ◽

Best Fitting ◽

Fold Cross Validation ◽

Fitting Model

Abstract Background Vietnam is undergoing a fast-aging process that poses potential critical issues for older people and central among those is demand for healthcare utilization. However, healthcare utilization, here measured as count data, creates challenges for modeling because such data typically has distributions that are skewed with a large mass at zero. This study compares empirical econometric strategies for the modeling of healthcare utilization (measured as the number of outpatient visits in the last 12 months) and identifies the determinants of healthcare utilization among Vietnamese older people based on the best-fitting model identified. Methods Using the Vietnam Household Living Standard Survey in 2006 (N = 2426), nine econometric regression models for count data were examined to identify the best-fitting one. We used model selection criteria, statistical tests and goodness-of-fit for in-sample model selection. In addition, we conducted 10-fold cross-validation checks to examine reliability of the in-sample model selection. Finally, we utilized marginal effects to identify the factors associated with the number of outpatient visits among Vietnamese older people based on the best-fitting model identified. Results We found strong evidence in favor of hurdle negative binomial model 2 (HNB2) for both in-sample selection and 10-fold cross-validation checks. The marginal effect results of the HNB2 showed that ethnicity, region, household size, health insurance, smoking status, non-communicable diseases, and disability were significantly associated with the number of outpatient visits. The predicted probabilities for each count event revealed the distinct trends of healthcare utilization among specific groups: at low count events, women and people in the younger age group used more healthcare utilization than did men and their counterparts in older age groups, but a reverse trend was found at higher count events. Conclusions The high degree of skewness and dispersion that typically characterizes healthcare utilization data affects the appropriateness of the econometric models that should be used in modeling such data. In the case of Vietnamese older people, our study findings suggest that hurdle negative binomial models should be used in the modeling of healthcare utilization given that the data-generating process reflects two different decision-making processes.

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Long-Term Healthcare Expenditures Following Combat-Related Traumatic Brain Injury

Military Medicine ◽

10.1093/milmed/usab248 ◽

2021 ◽

Author(s):

Michael K Dalton ◽

Molly P Jarman ◽

Adoma Manful ◽

Tracey P Koehlmoos ◽

Zara Cooper ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Healthcare Utilization ◽

Military Service ◽

Negative Binomial ◽

Service Members ◽

First Year ◽

Surveillance Period ◽

Healthcare Expenditures

ABSTRACT Background Traumatic brain injury (TBI) is one of the most common injuries resulting from U.S. Military engagements since 2001. Long-term consequences in terms of healthcare utilization are unknown. We sought to evaluate healthcare expenditures among U.S. military service members with TBI, as compared to a matched cohort of uninjured individuals. Methods We identified service members who were treated for an isolated combat-related TBI between 2007 and 2011. Controls consisted of hospitalized active duty service members, without any history of combat-related injury, matched by age, biologic sex, year of hospitalization, and duration of follow-up. Median total healthcare expenditures over the entire surveillance period represented our primary outcome. Expenditures in the first year (365 days) following injury (hospitalization for controls) and for subsequent years (366th day to last healthcare encounter) were considered secondarily. Negative binomial regression was used to identify the adjusted influence of TBI. Results The TBI cohort consisted of 634 individuals, and there were 1,268 controls. Healthcare expenditures among those with moderate/severe TBI (median $154,335; interquartile range [IQR] $88,088-$360,977) were significantly higher as compared to individuals with mild TBI (median $113,951; IQR $66,663-$210,014) and controls (median $43,077; IQR $24,403-$83,590; P < .001). Most expenditures were incurred during the first year following injury. Conclusion This investigation represents the first continuous observation of healthcare utilization among individuals with combat-related TBI. Our findings speak to continued consumption of health care well beyond the immediate postinjury period, resulting in total expenditures approximately six to seven times higher than those of service members hospitalized for noncombat-related reasons.

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Trends of limb amputation considering type, level, sex and age in Saskatchewan, Canada 2006–2019: an in-depth assessment

Archives of Public Health ◽

10.1186/s13690-021-00759-1 ◽

2022 ◽

Vol 80 (1) ◽

Author(s):

Samuel Kwaku Essien ◽

David Kopriva ◽

A. Gary Linassi ◽

Audrey Zucker-Levin

Keyword(s):

Negative Binomial ◽

Negative Binomial Regression ◽

Limb Amputation ◽

Annual Percent Change ◽

Discharge Data ◽

Resident Population ◽

True Incidence ◽

Depth Analysis ◽

The Impact ◽

Extremity Amputation

Abstract Background Most epidemiologic reports focus on lower extremity amputation (LEA) caused specifically by diabetes mellitus. However, narrowing scope disregards the impact of other causes and types of limb amputation (LA) diminishing the true incidence and societal burden. We explored the rates of LEA and upper extremity amputation (UEA) by level of amputation, sex and age over 14 years in Saskatchewan, Canada. Methods We calculated the differential impact of amputation type (LEA or UEA) and level (major or minor) of LA using retrospective linked hospital discharge data and demographic characteristics of all LA performed in Saskatchewan and resident population between 2006 and 2019. Rates were calculated from total yearly cases per yearly Saskatchewan resident population. Joinpoint regression was employed to quantify annual percentage change (APC) and average annual percent change (AAPC). Negative binomial regression was performed to determine if LA rates differed over time based on sex and age. Results Incidence of LEA (31.86 ± 2.85 per 100,000) predominated over UEA (5.84 ± 0.49 per 100,000) over the 14-year study period. The overall LEA rate did not change over the study period (AAPC -0.5 [95% CI − 3.8 to 3.0]) but fluctuations were identified. From 2008 to 2017 LEA rates increased (APC 3.15 [95% CI 1.1 to 5.2]) countered by two statistically insignificant periods of decline (2006–2008 and 2017–2019). From 2006 to 2019 the rate of minor LEA steadily increased (AAPC 3.9 [95% CI 2.4 to 5.4]) while major LEA decreased (AAPC -0.6 [95% CI − 2.1 to 5.4]). Fluctuations in the overall LEA rate nearly corresponded with fluctuations in major LEA with one period of rising rates from 2010 to 2017 (APC 4.2 [95% CI 0.9 to 7.6]) countered by two periods of decline 2006–2010 (APC -11.14 [95% CI − 16.4 to − 5.6]) and 2017–2019 (APC -19.49 [95% CI − 33.5 to − 2.5]). Overall UEA and minor UEA rates remained stable from 2006 to 2019 with too few major UEA performed for in-depth analysis. Males were twice as likely to undergo LA than females (RR = 2.2 [95% CI 1.99–2.51]) with no change in rate over the study period. Persons aged 50–74 years and 75+ years were respectively 5.9 (RR = 5.92 [95% Cl 5.39–6.51]) and 10.6 (RR = 10.58 [95% Cl 9.26–12.08]) times more likely to undergo LA than those aged 0–49 years. LA rate increased with increasing age over the study period. Conclusion The rise in the rate of minor LEA with simultaneous decline in the rate of major LEA concomitant with the rise in age of patients experiencing LA may reflect a paradigm shift in the management of diseases that lead to LEA. Further, this shift may alter demand for orthotic versus prosthetic intervention. A more granular look into the data is warranted to determine if performing minor LA diminishes the need for major LA.

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The association between an increased reimbursement cap for chronic disease coverage and healthcare utilization in China: an interrupted time series study

Health Policy and Planning ◽

10.1093/heapol/czaa087 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1029-1038 ◽

Cited By ~ 1

Author(s):

Menghan Shen ◽

Wen He ◽

Eng-Kiong Yeoh ◽

Yushan Wu

Keyword(s):

Time Series ◽

Chronic Disease ◽

Healthcare Utilization ◽

Interrupted Time Series ◽

Claim Data ◽

Health Events ◽

Outpatient Visits ◽

Insurance Claim Data ◽

Adverse Health Events ◽

Series Study

Abstract Hypertension and diabetes are highly prevalent in China and pose significant health and economic burdens, but large gaps in care remain for people with such conditions. In this article, drawing on administrative insurance claim data from China’s Urban Employee Basic Medical Insurance (UEBMI), we use an interrupted time series design to examine whether an increase in the monthly reimbursement cap for outpatient visits using chronic disease coverage affects healthcare utilization. The cap was increased by 50 yuan per chronic disease on 1 January 2016, in one of the largest cities in China. Compared with the year before the increase, patients with only hypertension increased their spending using chronic disease coverage by 17.8 yuan (P < 0.001) or 11.6%, and those with only diabetes increased their spending using chronic disease coverage by 19.5 yuan (P < 0.001) or 10.6%, with the differences almost entirely driven by spending on drugs. In addition, these two groups of patients reduced their spending using standard outpatient coverage by 13.9 yuan (P < 0.001) or 5.7% and 14.9 yuan (P = 0.03) or 5.2%, respectively, and thus had no changes in total outpatient spending. Patients with both hypertension and diabetes, meanwhile, increased their spending using chronic disease coverage by 54.8 yuan (P < 0.001) or 18.1% and decreased their spending using standard outpatient coverage by 16.1 yuan (P = 0.002) or 6.1%, with no changes in their probability of hospitalization. Among patients with both hypertension and diabetes who had fewer-than-average outpatient visits in 2015, the hospitalization rate decreased after the 2016 reimbursement cap increase (adjusted odds ratio = 0.702, P = 0.01). These findings suggest that increasing financial protection for patients with hypertension and diabetes may be an important strategy for reducing adverse health events, such as hospitalization, in China.

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Prevalence and Geographic Variations of Polypharmacy Among West Virginia Medicaid Beneficiaries

Annals of Pharmacotherapy ◽

10.1177/1060028017717017 ◽

2017 ◽

Vol 51 (11) ◽

pp. 981-989 ◽

Cited By ~ 7

Author(s):

Xue Feng ◽

Xi Tan ◽

Brittany Riley ◽

Tianyu Zheng ◽

Thomas K. Bias ◽

...

Keyword(s):

Logistic Regression ◽

West Virginia ◽

Healthcare Utilization ◽

Chronic Conditions ◽

Negative Binomial ◽

Spatial Association ◽

Emergency Department Visits ◽

Fee For Service ◽

Geographic Variations ◽

Medicaid Beneficiaries

Background: West Virginia (WV) residents are at high risk for polypharmacy given its considerable chronic disease burdens. Objective: To evaluate the prevalence, correlates, outcomes, and geographic variations of polypharmacy among WV Medicaid beneficiaries. Methods: In this cross-sectional study, we analyzed 2009-2010 WV Medicaid fee-for-service (FFS) claims data for adults aged 18-64 (N=37,570). We defined polypharmacy as simultaneous use of drugs from five or more different drug classes on a daily basis for at least 60 consecutive days in one year. Multilevel logistic regression was used to explore the individual- and county-level factors associated with polypharmacy. Its relationship with healthcare utilization was assessed using negative binomial regression and logistic regression. The univariate local indicators of spatial association method was applied to explore spatial patterns of polypharmacy in WV. Results: The prevalence of polypharmacy among WV Medicaid beneficiaries was 44.6%. High-high clusters of polypharmacy were identified in southern WV, indicating counties with above-average prevalence surrounded by counties with above-average prevalence. Polypharmacy was associated with being older, female, eligible for Medicaid due to cash assistance or medical eligibility, having any chronic conditions or more chronic conditions, and living in a county with lower levels of education. Polypharmacy was associated with more hospitalizations, emergency department visits, and outpatient visits, as well as higher non-drug medical expenditures. Conclusions: Polypharmacy was prevalent among WV Medicaid beneficiaries and was associated with substantial healthcare utilization and expenditures. The clustering of high prevalence of polypharmacy in southern WV may suggest targeted strategies to reduce polypharmacy burden in these areas.

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Impact of Gaps in Care during Adult Care Transfer in Sickle Cell Disease

Blood ◽

10.1182/blood-2021-150645 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 2992-2992

Author(s):

Kristen E Howell ◽

Mariam Kayle ◽

Matthew P Smeltzer ◽

Vikki Nolan ◽

James G Gurney ◽

...

Keyword(s):

Health Care ◽

Young Adults ◽

Healthcare Utilization ◽

Sickle Cell ◽

Healthcare Resource Utilization ◽

Adult Health ◽

Adult Care ◽

Outpatient Visits ◽

Acute Healthcare ◽

Transfer Interval

Abstract The transition from pediatric to adult health care is critical to the care of young adults with sickle cell disease (SCD). Young adults with SCD, compared with children with SCD, are at risk for a marked increase in disease severity, frequency of acute complications, healthcare utilization, and mortality. 1-4 Professional societies and healthcare experts recommend that young adults with chronic health conditions should transfer to adult-centered healthcare within 6 months of their last pediatric visit. 5-8 However, the effect of a 6-month transfer interval on healthcare utilization in SCD has not been studied. Given the complex health care needs of young adults with SCD, 9-15 it remains unclear whether the recommended 6-month transfer interval 5 is optimal. We hypothesized that longer gaps between pediatric and adult care would be associated with greater healthcare utilization in the first 2 to 6 years of adult care. This study included patients with SCD who were followed by a pediatric sickle cell program in the mid-southern US, participated in a transition to adult care program, 16 and fulfilled an initial adult visit to a partner adult SCD facility during the years 2011-2017. Participants were retrospectively followed from their first adult visit through December 31, 2017. Transfer gap was defined as the time (in months) between the last pediatric and the first adult sickle cell clinic visit. We estimated the association between varying transfer gaps from pediatric to adult care and the rate of healthcare utilization (inpatient, emergency department, and outpatient visits) in the first 2 to 6 years of adult care using negative binomial regression. Transfer gaps were evaluated at <2, ≥2 to <6, ≥6 to <9, and ≥9 months to evaluate whether adult health care utilization increased as the gap in SCD-specific care increased. Transfer gaps were also dichotomized at 6 months (>6 vs ≤6) to evaluate the current recommendation to complete transfer of patients to adult care within 6 months. 6,7 Healthcare resource utilization was analyzed for the complete follow-up (up to 6 years) and for the first 2 years of adult care to assess the immediate effects of delayed transfer. In total, 172 young adults with SCD (52% male, 63% HbSS/HbSβ 0-thalassemia) transferred to adult care at a median age of 18 years during the years 2011-2017 (Table 1). Approximately 83% of the included participants transferred to adult care within the recommended 6 months. young adults with transfer gaps ≥9 months had 2.86 (95%CI: 1.32, 6.20) times the rate of acute healthcare visits (inpatient and emergency department combined) compared to those with <2 months transfer gap (Table 2). The incidence rate ratio increased (IRR: 4.06; 95%CI: 1.65, 9.94) when evaluating the first 2 years of adult care. When evaluating the recommended transfer gap (6 months) as a dichotomous variable, those with gaps >6 months had 2.27 (95%CI: 1.18, 4.40) times the rate of acute care visits compared to those with ≤6 months transfer gap (Table 3). The incidence rate ratio increased slightly (IRR: 2.37; 95%CI: 1.29, 4.37) when evaluating the first 2 years of adult care only. There were no apparent associations between transfer gap duration and outpatient visits during the first 6 years in adult care; however, when restricted to the first 2 years of adult care, those with gaps >6 months had 1.32 (95%CI: 1.01, 1.72) times the rate of outpatient visits compared to those with gaps ≤6 months. Consistent with current guidelines, transfer gaps between pediatric and adult-centered care of greater than 6 months were found to be associated with increased acute healthcare resource utilization. Therefore, SCD transition programs would be well-served to consider policies for young adults that initiate adult care within 6 months of leaving pediatric care. Future studies should continue to investigate duration of transfer gaps from pediatric to adult care for their long-term clinical effects and explore interventions to reduce the transfer gap in the SCD population. Figure 1 Figure 1. Disclosures Shah: Novartis: Consultancy, Research Funding, Speakers Bureau; GBT: Research Funding, Speakers Bureau; Alexion: Speakers Bureau; Guidepoint Global: Consultancy; GLG: Consultancy; Emmaus: Consultancy. Hankins: Bluebird Bio: Consultancy; UpToDate: Consultancy; Vindico Medical Education: Consultancy; Global Blood Therapeutics: Consultancy.

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