Acute Care Utilization and Rehospitalizations for Sickle Cell Disease
Acute Care Utilization and Rehospitalizations for Sickle Cell Disease
复制标题
DOI：
10.1001/jama.2010.378
复制
发表时间：
2010-04-07
影响因子：
120.7
通讯作者：
Steiner, Claudia A.
中科院分区：
文献类型：
--
作者：
Brousseau, David C.;Owens, Pamela L.;Steiner, Claudia A.
背景已发表的镰状细胞病患者的医疗保健利用率和再住院率具有有限的普遍性，并且不是基于人群的。目的为镰状细胞病患者的急性医疗保健利用率和再住院率提供基准数据。设计镰状细胞病相关急诊科（艾德）的回顾性队列研究。2005年和2006年医疗保健成本和利用项目（HCUP）州住院病人数据库和州急诊部门数据库中选定州的就诊和住院情况。（亚利桑那、加州、佛罗里达、马萨诸塞州、密苏里州、纽约、南卡罗来纳州和田纳西州）提供加密标识符并具有足够数量的镰状细胞病患者;这些州共有33%的美国人患有镰状细胞病。患者共有21112名患者接受镰状细胞病相关的治疗和释放艾德就诊或住院治疗。主要结果测量急性护理利用率和再住院率。结果21112例镰状细胞病患者共就诊109344人次，平均2.59人次（95%置信区间[CI]，2.53-2.65）每年每例患者的就诊次数，1.52（95% CI，1.48-1.55），治疗后出院艾德访视为1.08（95% CI，1.04-1.11）。18- 30岁人群的利用率最高，每年每例患者3.61次（95%CI，3.47-3.75），而那些有公共保险的人，每年每例患者3.22次（95%CI，3.13-3.31）。公共保险的18至30岁的人有4.80（95%CI，4.58-5.02），每年每例患者的遭遇。大约29%的人口没有遭遇，而16.9%的人每年有3次或更多的遭遇。30天和14天再住院率分别为33.4%（95%CI，33.0%-33.8%）和22.1%（95%CI，21.8%-22.4%）。18- 30岁人群的再住院率最高，30天内再住院率为41.1%（95%CI，40.5%-41.7%），14天内再住院率为28.4%（95%CI，27.8%-29.0%）。再住院也是最高的公共保险patients.Conclusion镰状细胞病患者，急性护理的遭遇和再住院是频繁的，特别是18- 30岁的年轻人。美国医学会杂志2010; 303（13）：1288-1294
Context Published rates of health care utilization and rehospitalization by people with sickle cell disease have had limited generalizability and are not population based.Objective To provide benchmark data for rates of acute care utilization and rehospitalizations for patients with sickle cell disease.Design Retrospective cohort of sickle cell disease-related emergency department (ED) visits and hospitalizations from select states in the 2005 and 2006 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and State Emergency Department Databases.Setting Eight geographically dispersed states (Arizona, California, Florida, Massachusetts, Missouri, New York, South Carolina, and Tennessee) that provide encrypted identifiers and have sufficient numbers of patients with sickle cell disease; together these states have 33% of the US population with sickle cell disease.Patients A total of 21 112 patients with sickle cell-related treat-and-release ED visits or inpatient hospitalizations.Main Outcome Measures Rates of acute care utilization and rehospitalizations. Population-based utilization rates were also calculated.Results The 21 112 people with sickle cell disease had 109 344 encounters, a mean of 2.59 (95% confidence interval [CI], 2.53-2.65) encounters per patient per year, 1.52 (95% CI, 1.48-1.55) encounters for hospitalizations and 1.08 (95% CI, 1.04-1.11) for treat-and-release ED visits. Utilization was highest for 18- to 30-year-olds, 3.61 (95% CI, 3.47-3.75) encounters per patient per year, and those with public insurance, 3.22 (95% CI, 3.13-3.31) encounters per patient per year. Publicly insured 18- to 30-year-olds had 4.80 (95% CI, 4.58-5.02) encounters per patient per year. Approximately 29% of the population had no encounters while 16.9% had 3 or more encounters per year. The 30-day and 14-day rehospitalization rates were 33.4% (95% CI, 33.0%-33.8%) and 22.1% (95% CI, 21.8%-22.4%), respectively. The rehospitalization rate was highest for 18- to 30-year-olds, with 41.1% (95% CI, 40.5%-41.7%) rehospitalized within 30 days and 28.4% (95% CI, 27.8%-29.0%) within 14 days. Rehospitalizations were also highest for publicly insured patients.Conclusion Among patients with sickle cell disease, acute care encounters and rehospitalizations were frequent, particularly for 18- to 30-year-olds. JAMA. 2010; 303(13): 1288-1294