Household material hardships impact emergency department reliance in pediatric patients with sickle cell disease
Background In sickle cell disease (SCD), high emergency department (ED) utilization is associated with worse outcomes and increased costs. A metric called ED reliance (EDr), the percentage of healthcare visits that occur in the ED, attempts to identify ED overutilization. It is unknown if household...
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| Veröffentlicht in: | Pediatric blood & cancer 2020-10, Vol.67 (10), p.e28587-n/a |
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| creator | Power‐Hays, Alexandra Patterson, Alyssa Sobota, Amy |
| description | Background
In sickle cell disease (SCD), high emergency department (ED) utilization is associated with worse outcomes and increased costs. A metric called ED reliance (EDr), the percentage of healthcare visits that occur in the ED, attempts to identify ED overutilization. It is unknown if household material hardships (HMH)—housing, utility, or food insecurity—impact reliance on the ED. As these may represent modifiable risk factors for high ED utilization, we aimed to estimate the association between HMH and EDr in pediatric patients with SCD.
Methods
We reviewed the electronic medical records of pediatric patients with SCD who received care in the Boston Medical Center network in Massachusetts, USA, to collect data on HMH and healthcare utilization. Using linear regression to control for potential confounders, we modeled the association between material hardships and EDr.
Results
Of 101 eligible patients, 60 (59%) reported one or more HMH. The mean EDr was 12% overall, with significant differences between those with and without HMH (15.9 vs 5.9, P = 0.0001). Each additional hardship experienced was associated with an increased average EDr of 7.7 percentage points (R2 = 0.34, P |
| doi_str_mv | 10.1002/pbc.28587 |
| format | Article |
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In sickle cell disease (SCD), high emergency department (ED) utilization is associated with worse outcomes and increased costs. A metric called ED reliance (EDr), the percentage of healthcare visits that occur in the ED, attempts to identify ED overutilization. It is unknown if household material hardships (HMH)—housing, utility, or food insecurity—impact reliance on the ED. As these may represent modifiable risk factors for high ED utilization, we aimed to estimate the association between HMH and EDr in pediatric patients with SCD.
Methods
We reviewed the electronic medical records of pediatric patients with SCD who received care in the Boston Medical Center network in Massachusetts, USA, to collect data on HMH and healthcare utilization. Using linear regression to control for potential confounders, we modeled the association between material hardships and EDr.
Results
Of 101 eligible patients, 60 (59%) reported one or more HMH. The mean EDr was 12% overall, with significant differences between those with and without HMH (15.9 vs 5.9, P = 0.0001). Each additional hardship experienced was associated with an increased average EDr of 7.7 percentage points (R2 = 0.34, P < 0.0001). Housing and utility hardships were each independently associated with increased EDr.
Conclusion
HMH are associated with significantly increased EDr in children with SCD, independent of transportation hardship or insurance type. Through screening for HMH, providers and health systems could identify at‐risk patients with modifiable risk factors for high EDr in order to provide them additional support.</description><identifier>ISSN: 1545-5009</identifier><identifier>EISSN: 1545-5017</identifier><identifier>DOI: 10.1002/pbc.28587</identifier><identifier>PMID: 32716125</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Anemia, Sickle Cell - therapy ; Child ; Child, Preschool ; Electronic medical records ; emergency department utilization ; Emergency medical care ; Emergency Service, Hospital - statistics & numerical data ; Female ; Follow-Up Studies ; Food security ; health services ; Hematology ; Hospitalization - statistics & numerical data ; Humans ; Infant ; Male ; Oncology ; Patient Acceptance of Health Care - statistics & numerical data ; Patients ; Pediatrics ; Prognosis ; Retrospective Studies ; Risk Factors ; Sickle cell disease ; social determinants of health ; Socioeconomic Factors</subject><ispartof>Pediatric blood & cancer, 2020-10, Vol.67 (10), p.e28587-n/a</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3537-adfa0097a9bbc09ff6465028f4541fe8561340a01967e1e575a3b33d0ca226813</citedby><cites>FETCH-LOGICAL-c3537-adfa0097a9bbc09ff6465028f4541fe8561340a01967e1e575a3b33d0ca226813</cites><orcidid>0000-0002-5823-0218 ; 0000-0003-3979-7435</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fpbc.28587$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fpbc.28587$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32716125$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Power‐Hays, Alexandra</creatorcontrib><creatorcontrib>Patterson, Alyssa</creatorcontrib><creatorcontrib>Sobota, Amy</creatorcontrib><title>Household material hardships impact emergency department reliance in pediatric patients with sickle cell disease</title><title>Pediatric blood & cancer</title><addtitle>Pediatr Blood Cancer</addtitle><description>Background
In sickle cell disease (SCD), high emergency department (ED) utilization is associated with worse outcomes and increased costs. A metric called ED reliance (EDr), the percentage of healthcare visits that occur in the ED, attempts to identify ED overutilization. It is unknown if household material hardships (HMH)—housing, utility, or food insecurity—impact reliance on the ED. As these may represent modifiable risk factors for high ED utilization, we aimed to estimate the association between HMH and EDr in pediatric patients with SCD.
Methods
We reviewed the electronic medical records of pediatric patients with SCD who received care in the Boston Medical Center network in Massachusetts, USA, to collect data on HMH and healthcare utilization. Using linear regression to control for potential confounders, we modeled the association between material hardships and EDr.
Results
Of 101 eligible patients, 60 (59%) reported one or more HMH. The mean EDr was 12% overall, with significant differences between those with and without HMH (15.9 vs 5.9, P = 0.0001). Each additional hardship experienced was associated with an increased average EDr of 7.7 percentage points (R2 = 0.34, P < 0.0001). Housing and utility hardships were each independently associated with increased EDr.
Conclusion
HMH are associated with significantly increased EDr in children with SCD, independent of transportation hardship or insurance type. Through screening for HMH, providers and health systems could identify at‐risk patients with modifiable risk factors for high EDr in order to provide them additional support.</description><subject>Adolescent</subject><subject>Anemia, Sickle Cell - therapy</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Electronic medical records</subject><subject>emergency department utilization</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Food security</subject><subject>health services</subject><subject>Hematology</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Oncology</subject><subject>Patient Acceptance of Health Care - statistics & numerical data</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sickle cell disease</subject><subject>social determinants of health</subject><subject>Socioeconomic Factors</subject><issn>1545-5009</issn><issn>1545-5017</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10ctKxDAUBuAgiveFLyABN7oYJ5cmaZc6eIMBXei6nKanTrSXmHSQeXujoy4EVwnk4-fk_IQccXbOGRNTX9lzkavcbJBdrjI1UYybzd87K3bIXowviWqm8m2yI4Xhmgu1S_ztsIy4GNqadjBicNDSBYQ6LpyP1HUe7Eixw_CMvV3RGj2EscN-pAFbB71F6nrqsXYwBmeph9Gl10jf3big0dnXFqnFtqW1iwgRD8hWA23Ew-9znzxdXz3Obifz-5u72cV8YqWSZgJ1A2lwA0VVWVY0jc60YiJvMpXxBnOlucwYMF5ogxyVUSArKWtmQQidc7lPTte5PgxvS4xj2bn4OQj0mL5cikwYJUSW6URP_tCXYRn6NF1SUuvC5FwkdbZWNgwxBmxKH1wHYVVyVn7WUKYayq8akj3-TlxWHda_8mfvCUzX4N21uPo_qXy4nK0jPwD8ppHG</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Power‐Hays, Alexandra</creator><creator>Patterson, Alyssa</creator><creator>Sobota, Amy</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5823-0218</orcidid><orcidid>https://orcid.org/0000-0003-3979-7435</orcidid></search><sort><creationdate>202010</creationdate><title>Household material hardships impact emergency department reliance in pediatric patients with sickle cell disease</title><author>Power‐Hays, Alexandra ; Patterson, Alyssa ; Sobota, Amy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3537-adfa0097a9bbc09ff6465028f4541fe8561340a01967e1e575a3b33d0ca226813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Anemia, Sickle Cell - therapy</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Electronic medical records</topic><topic>emergency department utilization</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Food security</topic><topic>health services</topic><topic>Hematology</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>Oncology</topic><topic>Patient Acceptance of Health Care - statistics & numerical data</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sickle cell disease</topic><topic>social determinants of health</topic><topic>Socioeconomic Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Power‐Hays, Alexandra</creatorcontrib><creatorcontrib>Patterson, Alyssa</creatorcontrib><creatorcontrib>Sobota, Amy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric blood & cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Power‐Hays, Alexandra</au><au>Patterson, Alyssa</au><au>Sobota, Amy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Household material hardships impact emergency department reliance in pediatric patients with sickle cell disease</atitle><jtitle>Pediatric blood & cancer</jtitle><addtitle>Pediatr Blood Cancer</addtitle><date>2020-10</date><risdate>2020</risdate><volume>67</volume><issue>10</issue><spage>e28587</spage><epage>n/a</epage><pages>e28587-n/a</pages><issn>1545-5009</issn><eissn>1545-5017</eissn><abstract>Background
In sickle cell disease (SCD), high emergency department (ED) utilization is associated with worse outcomes and increased costs. A metric called ED reliance (EDr), the percentage of healthcare visits that occur in the ED, attempts to identify ED overutilization. It is unknown if household material hardships (HMH)—housing, utility, or food insecurity—impact reliance on the ED. As these may represent modifiable risk factors for high ED utilization, we aimed to estimate the association between HMH and EDr in pediatric patients with SCD.
Methods
We reviewed the electronic medical records of pediatric patients with SCD who received care in the Boston Medical Center network in Massachusetts, USA, to collect data on HMH and healthcare utilization. Using linear regression to control for potential confounders, we modeled the association between material hardships and EDr.
Results
Of 101 eligible patients, 60 (59%) reported one or more HMH. The mean EDr was 12% overall, with significant differences between those with and without HMH (15.9 vs 5.9, P = 0.0001). Each additional hardship experienced was associated with an increased average EDr of 7.7 percentage points (R2 = 0.34, P < 0.0001). Housing and utility hardships were each independently associated with increased EDr.
Conclusion
HMH are associated with significantly increased EDr in children with SCD, independent of transportation hardship or insurance type. Through screening for HMH, providers and health systems could identify at‐risk patients with modifiable risk factors for high EDr in order to provide them additional support.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32716125</pmid><doi>10.1002/pbc.28587</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5823-0218</orcidid><orcidid>https://orcid.org/0000-0003-3979-7435</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adolescent Anemia, Sickle Cell - therapy Child Child, Preschool Electronic medical records emergency department utilization Emergency medical care Emergency Service, Hospital - statistics & numerical data Female Follow-Up Studies Food security health services Hematology Hospitalization - statistics & numerical data Humans Infant Male Oncology Patient Acceptance of Health Care - statistics & numerical data Patients Pediatrics Prognosis Retrospective Studies Risk Factors Sickle cell disease social determinants of health Socioeconomic Factors |
| title | Household material hardships impact emergency department reliance in pediatric patients with sickle cell disease |
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