Results from a cross-sectional cohort study indicate missing appointments may be significantly associated with hospital admission and readmission in patients with sickle cell disease. This study, published in Hematology, also indicates mental health, spirituality, age, financial insecurity, and clinic attendance as additional factors associated with admission and readmission.
Hospital admissions and readmissions can be costly and can negatively affect the quality of life for patients with sickle cell disease. Of note, more than 90% of hospital admissions for sickle cell disease are to treat acute pain. Adults are more likely than children to be admitted and readmitted to the hospital.
To evaluate what factors are predictive of admission and readmission, researchers conducted a cross-sectional study at 6 sickle cell centers across the United States. Surveys were administered to 201 adult patients and 330 caregivers of pediatric patients with sickle cell disease between October 2014 and March 2016.
The survey assessed social determinants of health, including race, ethnicity, sex, educational attainment, marital status, and difficulty paying bills. Caregivers responded about themselves regarding marital status and difficulty paying bills but responded about the child for other questions. The Patient Health Questionnaire, a validated 2-item screening used to assess the frequency of depressed mood and loss of pleasure over the previous 2 weeks, was used to evaluate depressive symptoms. The survey also gathered information on spirituality, social support, health literacy, missed clinic appointments, hospital admissions, and 30-day readmissions.
A total of 64% of adult patients and 43% of pediatric patients were admitted to the hospital. Only 9% of children were readmitted, but 28% of adult patients were readmitted. Uncontrolled pain was the most common reason for hospitalization, accounting for 84% of adult admissions, 83% of adult readmissions, 69% of pediatric admissions, and 69% of pediatric readmissions.
Of note, children were less likely than adults to be hospitalized by either admission (odds ratio [OR], 0.35; 95% CI, 0.23-0.52) or readmission (OR, 0.23; 95% CI, 0.13-0.41).
Across pediatric and adult patients, missing clinic appointments correlated with admissions (OR, 1.66; 95% CI, 1.07-2.58) and readmissions (OR, 2.68; 95% CI, 1.28-6.29). In both children and adults, depressive symptoms also associated with admissions (OR, 1.36; 95% CI, 1.16-1.59) and readmissions (OR, 1.24; 95% CI, 1.04-1.49).
In adult patients, higher spirituality associated with fewer readmissions (OR, 0.39; 95% CI, 0.18-0.81) and difficulty paying bills associated with more admissions (OR, 3.11; 95% CI, 1.47-6.62) and readmissions (OR, 3.7; 95% CI, 1.76-7.79).
“Interventions to improve clinic appointment keeping, address depressive symptoms, and improve the transition from the pediatric to [the] adult model of care could potentially reduce admissions and readmissions for this population,” the authors concluded.
1. Cronin RM, Hankins JS, Byrd J, et al. Risk factors for hospitalizations and readmissions among individuals with sickle cell disease: results of a U.S. survey study. Hematology. 2019 Dec;24(1):189-198. doi:10.1080/16078454.2018.1549801