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Impact of proximity to comprehensive sickle cell center on utilization of healthcare services among children with sickle cell disease.

Abstract

BACKGROUND

The impact of comprehensive care on utilization of healthcare services by children with sickle cell disease (SCD) has not been fully evaluated. We compared the medical care utilization and mortality in children less than 20 years of age with SCD in four regions in the state of Tennessee with and without a comprehensive sickle cell center (CSCC).

METHODS

Rates of hospitalizations, outpatient and emergency department (ED) visits, and deaths were measured in a cohort of children aged <20 years with SCD, enrolled in TennCare, from January 1995 to December 2002. TennCare data linked to Tennessee vital records were used to define the population and identify the outcomes. The patients were classified into one of four regions based on their residential address on the day of their hospitalization or outpatient visit.

RESULTS

The cohort consisted of 1,214 children with 6,393 person-years of follow-up. Fifty-six percent of patients resided in the region with the CSCC. This region had the highest overall rates of hospitalization for all children (P < 0.001), while ED and outpatient visits were higher in other areas. The death rates ranged from 1.8 to 4.3 per 1,000 person-years in the four regions and did not represent statistically significant differences.

CONCLUSION

No clear pattern of improved utilization of medical care services were identified in relation to proximity of residence to a CSCC. This cohort was not large enough to detect small differences in death rates. In addition, other outcomes that incorporate quality of life measures may be more sensitive to differences in medical care.

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  • Authors+Show Affiliations

    ,

    Department of Pediatrics, Division of Pediatric Hematology/Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. sadhna.shankar@vanderbilt.edu

    , , , ,

    Source

    Pediatric blood & cancer 50:1 2008 Jan pg 66-71

    MeSH

    Adolescent
    Adult
    Ambulatory Care
    Anemia, Sickle Cell
    Child
    Child, Preschool
    Emergency Service, Hospital
    Female
    Health Services
    Health Services Accessibility
    Hospitalization
    Humans
    Infant
    Male
    Tennessee

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    16998856

    Citation

    Shankar, Sadhna M., et al. "Impact of Proximity to Comprehensive Sickle Cell Center On Utilization of Healthcare Services Among Children With Sickle Cell Disease." Pediatric Blood & Cancer, vol. 50, no. 1, 2008, pp. 66-71.
    Shankar SM, Arbogast PG, Mitchel E, et al. Impact of proximity to comprehensive sickle cell center on utilization of healthcare services among children with sickle cell disease. Pediatr Blood Cancer. 2008;50(1):66-71.
    Shankar, S. M., Arbogast, P. G., Mitchel, E., Ding, H., Wang, W. C., & Griffin, M. R. (2008). Impact of proximity to comprehensive sickle cell center on utilization of healthcare services among children with sickle cell disease. Pediatric Blood & Cancer, 50(1), pp. 66-71.
    Shankar SM, et al. Impact of Proximity to Comprehensive Sickle Cell Center On Utilization of Healthcare Services Among Children With Sickle Cell Disease. Pediatr Blood Cancer. 2008;50(1):66-71. PubMed PMID: 16998856.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Impact of proximity to comprehensive sickle cell center on utilization of healthcare services among children with sickle cell disease. AU - Shankar,Sadhna M, AU - Arbogast,Patrick G, AU - Mitchel,Ed, AU - Ding,Hua, AU - Wang,Winfred C, AU - Griffin,Marie R, PY - 2006/9/26/pubmed PY - 2008/1/9/medline PY - 2006/9/26/entrez SP - 66 EP - 71 JF - Pediatric blood & cancer JO - Pediatr Blood Cancer VL - 50 IS - 1 N2 - BACKGROUND: The impact of comprehensive care on utilization of healthcare services by children with sickle cell disease (SCD) has not been fully evaluated. We compared the medical care utilization and mortality in children less than 20 years of age with SCD in four regions in the state of Tennessee with and without a comprehensive sickle cell center (CSCC). METHODS: Rates of hospitalizations, outpatient and emergency department (ED) visits, and deaths were measured in a cohort of children aged <20 years with SCD, enrolled in TennCare, from January 1995 to December 2002. TennCare data linked to Tennessee vital records were used to define the population and identify the outcomes. The patients were classified into one of four regions based on their residential address on the day of their hospitalization or outpatient visit. RESULTS: The cohort consisted of 1,214 children with 6,393 person-years of follow-up. Fifty-six percent of patients resided in the region with the CSCC. This region had the highest overall rates of hospitalization for all children (P < 0.001), while ED and outpatient visits were higher in other areas. The death rates ranged from 1.8 to 4.3 per 1,000 person-years in the four regions and did not represent statistically significant differences. CONCLUSION: No clear pattern of improved utilization of medical care services were identified in relation to proximity of residence to a CSCC. This cohort was not large enough to detect small differences in death rates. In addition, other outcomes that incorporate quality of life measures may be more sensitive to differences in medical care. SN - 1545-5017 UR - https://www.unboundmedicine.com/medline/citation/16998856/Impact_of_proximity_to_comprehensive_sickle_cell_center_on_utilization_of_healthcare_services_among_children_with_sickle_cell_disease_ L2 - https://doi.org/10.1002/pbc.21066 DB - PRIME DP - Unbound Medicine ER -