When children with sickle‐cell disease become adults: Lack of outpatient care leads to increased use of the emergency department

Abstract

Young adults with sickle-cell disease have increased emergency department (ED) utilization and increased risk of mortality for unclear reasons. Emergency Department Reliance (EDR) differentiates excessive ED use due to increased need in chronic illness from increased use due to limited access to outpatient care. A higher EDR has been used to define excessive reliance on the ED and thus access to care issues leading to increased ED utilization. We conducted a retrospective cohort study of sickle-cell disease patients within the Wisconsin Medicaid database over a 5-year period to examine EDR during the transition period from childhood to adulthood. The study population included four distinct groups: (1) children, (2) patients transitioning from pediatric to adult providers, (3) young adults, and (4) adults age 31-45. Rates of visits per year were calculated for ED visits and outpatient visits for all diagnoses and sickle-cell disease-related diagnoses. Overall, we found increased EDR among the transition group and young adults compared to children and adults for sickle-cell disease-related diagnoses. These findings suggest access to care issues play a significant role in the increased ED utilization seen during the transition period from pediatric to adult providers in sickle-cell disease.