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3181 Outpatient Visits, Hospitalizations and Emergency Department Visits Among Patients with Sickle Cell Disease On Medicaid: Trends in 14 USA States, 2006-2007

Program: Oral and Poster Abstracts
Session: 901. Health Services and Outcomes Research: Poster II
Sunday, December 9, 2012, 6:00 PM-8:00 PM
Hall B1-B2, Level 1, Building B (Georgia World Congress Center)

Benjamin Ansa, MD1*, Tom Adamkiewicz, MD, MSCR, FRCP(C)2, Yvonne Fry-Johnson, MD, MSCR1*, Gregory Strayhorn, MD, PhD2*, Barbara Moore1* and George S Rust, MD, MPH1*

1National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
2Family Medicine, Morehouse School of Medicine, East Point, GA

Sickle cell disease (SCD) is an inherited hematological disorder affecting 90,000-100,000 Americans. Public insurance accounts for the major method of reimbursement for medical care utilization in this population. Few published population-based studies describe outpatient visits, hospitalizations and emergency department visits together. This study examined rates of hospitalizations, outpatient visits (OPV) and emergency department visits (EDV) among children and adults with SCD across fourteen states of the United States, using a relational  claims database, to determine any differences across age groups, genders and states (Medicaid Analytic eXtract [MAX] files, of the Center for Medicare and Medicaid Services). Visits information was extracted using ICD-9-CM codes for SCD, as well as procedure codes (cpt) to determine OPV and EDV. All SCD cases with 24 months continuous Medicaid eligibility for the period under study (2006 to 2007) were identified, and the pattern of medical care utilization was examined. A total of 19,168 pediatric and adult SCD patients were identified to have enrolled in Medicaid with eligibility for the years 2006 and 2007. The mean age was 22.06 years; range: <1year-93years; males and females accounted for 7,402(38.6%) and 11,763(61.4%) respectively with 3 cases of unknown gender. The highest number of cases (2,353[12.3%]) presented in Florida, while Georgia and Louisiana followed with 2,130(11.1%) and 1,883(9.8%) patients respectively (other states included Alabama, Arkansas, Kentucky, Maryland, Missouri, Mississippi, North & South Carolina, Tennessee, Texas and Virginia). The <1-10 years age group represented 25.2% of cases, and majority of the cases were 11-20 years old (27.4%), with a decline in the number of cases as the age increased. Patients identified as Blacks/African Americans made up 80.5% of the SCD population. After the age of 21 years, there were considerably more female SCD patients enrolled in Medicaid, compared to males. There were 94,891 OPV recorded within the two year period, 61,762 hospitalizations and 146,163 EDV. The yearly rate for OPV ranged from 0.5-15.1 per 1000 visits, for hospitalization, 0.4-8.9 per 1000 visits, and for EDV, 2-22.9 per 1000 visits. Patients that were in the <1-10 years age group had the most OPV (15.1 per 1,000 visits yearly rate), and those over 50 years had the least OPV (2.1 per 1000 visits yearly). Hospitalization and EDV rates were highest among patients that were between 21 and 30 years old (8.9 and 22.9 per 1,000 visits yearly, respectively), and lowest for the over 50 years group (1.5 and 2.0 per 1000 visits yearly). In summary, patterns medical service utilization in patients with SCD on Medicaid, representing approximately 1/5 to 1/4 of the estimated USA patient population. Utilization of care changed significantly as children transitioned into adulthood:  OPV decreased, while hospitalization and, in particular, EDV increased and peaked in young adults. The emergency department, as the commonest place for service among young adults with SCD, may be a strategic focal point for promoting disease prevention programs.

Medical Care Utilization by SCD Patients by Age (years) and Gender, 2006-2007 (MAX)*

Age

(years)

Total # of SCD Patients

N=19168(100%)

Total OPV

N=94891(100%)

Yearly rate of OPV

/1000

Total EDV

N=146163(100%)

Yearly rate of EDV

/1000

Total Hosp.

N=61762(100%)

Yearly rate of Hosp.

/1000

<1-10

4825 (25.2%)

30193 (31.8%)

15.1

  6043 (4.1%)

3.0

10564 (17.1%)

5.3

11-20

5247 (27.4%)

27990 (29.5%)

14

35599 (24.4%)

17.8

15942 (25.8%)

8.0

21-30

4480 (23.4%)

16552 (17.4%)

8.3

45820 (31.3%)

22.9

17735 (28.7%)

8.9

31-40

2166 (11.3%)

   9315 (9.8%) 

4.7

23418 (16.0%)

11.7

  9101 (14.7%)

4.6

41-50

1444 (7.5%)

   6657 (7.0%)

3.3

11780 (8.1%)

5.9

  5428 (8.8%)

2.7

51-60

  683 (3.6%)

   3255 (3.4%)

1.6

  4097 (2.8%)

2.0

  2182 (3.5%)

1.1

>60

  323 (1.7%)

     929 (1.0%)

0.5

19406 (13.3%)

9.7

    810 (1.3%)

0.4

pvalue(Age)

 

0.0001

 

0.0001

 

0.0001

 

 

 

 

 

 

 

 

 

Gender

 

 

 

 

 

 

 

Female

11763 (61.4%)

57297 (60.4%)

28.6

88811 (60.8%)

44.4

37633 (60.9%)

18.8

Male

   7402 (38.6%)

37582 (39.6%)

18.8

57346 (39.2%)

28.7

24125 (39.1%)

12.1

Unknown

         3 (0%)

       12 (0%)

 

         6 (0%)

 

         4 (0%)

 

pvalue(Gender)

 

0.0001

 

0.0001

 

0.0001

 

Yearly Rate of Medical Care Utilization by SCD Patients by Age (years)/1000 visits (MAX)*

*MAX: Medicaid Analytic eXtract files 2006-2007

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH