The need for care integration across hospital services for adults with sickle cell disease

Purpose: The purpose of this paper is to examine the risk factors and characteristics that influence the integration of quality care across hospital services by adult Sickle cell disease (SCD) patients. Design/methodology/approach: This paper is a systematic review. Findings: Painful vaso-occlusive crisis was the major cause of hospital and emergency department admissions in patients with SCD, although high utilizing patients had more diagnoses of acute chest syndrome and sepsis. High utilizers also had more SCD complications (aseptic necrosis) and infections. Patients who were publically insured accounted for 76.5 percent (95% CI: 0.632–0.861) of all patients. Patients aged 18–30 years had the highest rate of utilization, which declined in those over 50. Women were more likely than men to seek hospital services. Research limitations/implications: There is a need for prospective studies with a prolonged follow-up, reasonable sample size, objective methods of data collection and similar outcome measures that address characteristics of utilization and integration across different clinical settings for this population. Practical implications: There is a small subset of patients with SCD who consume a large percentage of resources. This may lend itself well to targeted collaborative and integrated care management services for these high consumers of healthcare resources. Social implications: SCD patients who used hospital services for care, regardless of the frequency of their encounters, were more likely young women who relied heavily on public insurance to seek relief from the pain of vaso-occlusive crises. The majority were from African–American and Hispanic communities. Originality/value: This study examines the consumption of resources by a high utilizing group as a necessary step in the development of an integrated care management pathway.