The Course and Correlates of High Hospital Utilization in Sickle Cell Disease: Evidence from a large urban Medicaid Managed Care Organization

摘要

Although most patients with sickle cell disease (SCD) are hospitalized infrequently and manage painful crises at home, a small subpopulation is frequently admitted to emergency departments and inpatient units. This small group accounts for the majority of health care expenses for patients with sickle cell disease. Using inpatient claims data from a large, urban Medicaid MCO for five consecutive years, this study sought to describe the course of high inpatient utilization (averaging four or more admissions per year enrolled for at least one year) in members with a diagnosis of sickle cell disease and a history of hospitalizations for vaso-occlusive crisis. High utilizers were compared with other members with SCD on demographics, medical and psychiatric comorbidity, and use of other health care resources. Members who were high utilizers had more diagnostic mentions of sickle cell complications than low utilizers. However, the pattern of high inpatient utilization was likely to moderate over successive years, and return to the pattern after moderation was uncommon. Despite this, a small subpopulation engaged in exceptional levels of inpatient utilization over multiple years.