Redefining High Emergency Department Utilization for Sickle Cell Disease.

Area of Science:

• Hematology
• Public Health
• Health Services Research

Background:

• Sickle cell disease (SCD) is a significant hemoglobinopathy with vaso-occlusive episodes driving frequent emergency department (ED) visits.
• A standardized definition for high ED utilization in SCD patients is currently lacking in medical literature.
• Understanding ED utilization patterns is crucial for managing SCD and allocating healthcare resources effectively.

Purpose of the Study:

• To investigate emergency department (ED) utilization patterns among individuals with sickle cell disease (SCD).
• To establish a redefined, data-informed classification for high ED utilization within the SCD population.
• To identify demographic and socioeconomic factors associated with super-high ED utilization in SCD patients.

Main Methods:

• A retrospective cohort study utilizing North Carolina Hospital Discharge Datasets from 2013-2019.
• Inclusion criteria required at least 3 SCD-related visits (ED, inpatient, or outpatient surgery) within a 5-year period.
• Analysis involved examining ED visit distributions, univariate comparisons, and multinomial regression to identify factors associated with utilization categories.

Main Results:

• The study analyzed 9,964 unique SCD patients with 100,188 ED visits, categorizing utilization into low (0-1), moderate (2-9), high (10-32), and super-high (≥33 visits/year).
• A small subset (1.79%) of patients exhibited super-high ED utilization, disproportionately contributing to total visits.
• Higher ED utilization was significantly associated with older age, younger age at death, higher social vulnerability index (SVI), and residing in more disadvantaged counties.

Conclusions:

• This study introduces four novel categories for ED utilization in SCD, offering a framework to redefine high ED use.
• The findings highlight the disproportionate impact of super-high ED users and associated risk factors, including social determinants of health.
• These new categories can inform targeted interventions and resource allocation for individuals with SCD experiencing high healthcare utilization.