One-third of sickle cell patients rehospitalized within 30 days of discharge
Put words in our mouth
One-third of people with sickle cell disease are rehospitalized within 30 days of discharge, and 18- to 30-year-olds are particularly likely to be rehospitalized or have return visits to the emergency department, a new study found.
Researchers examined data on 21,112 patients from the 2005 and 2006 Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department (ED) Databases. Patients came from eight geographically diverse states—together comprising 33% of all people with sickle cell disease in the U.S.—and had had sickle cell-related treat-and-release ED visits or inpatient hospitalizations. Results were published in the April 7 Journal of the American Medical Association.
The 30-day rehospitalization rate was 33.4% (95% CI, 33.0% to 33.8%), while the 14-day rate was 22.1% (95% CI, 21.8% to 22.4%). In addition to rehospitalizations, 15% of hospital discharges were followed by a treat-and-release ED visit within 30 days (95% CI, 14.7% to 15.3%). Rehospitalization rates were highest for patients age 18 to 30 years, with 41.1% rehospitalized within 30 days (95% CI, 40.5% to 41.7%) and 28.4% within 14 days (95% CI, 27.8% to 29%). This age group was also more likely to go to the ED for treatment of pain, then be released. Medicaid patients, or those with other types of public insurance, had higher rates than privately insured or uninsured patients. A shorter length of stay wasn't greatly associated with rehospitalization.
Fourteen-day rehospitalization rates may seem a more appropriate time period to evaluate inpatient care, while 30-day rates may assess the quality of ambulatory care; however, two-thirds of those rehospitalized within 30 days were rehospitalized within 14 days, the authors noted. Preventing 14-day rehospitalizations “may require evaluation and intervention during the (original) hospitalization,” they said.
The high utilization rate among 18- to 30-year-olds, compared to older age groups, probably reflects the fact that those with severe disease die earlier, leaving fewer people with severe disease as the population ages, they said. Identifying benchmarks can help with efforts to improve quality of care and reduce morbidity, they concluded.