Caring for the adult with sickle cell disease: results of a multidisciplinary pilot program

Abstract

Background: Care for adults with sickle cell disease (SCD) is often fragmented and costly. The chronic care model is recommended as a best practice approach to providing care for patients with chronic disease. However, no published reports exist examining the effectiveness of this approach in adults with SCD.

Purpose: To examine selected quality and utilization measures at baseline and following implementation of a new multidisciplinary program for adults with SCD at one academic institution.

Methods: Administrative data were obtained for all adults with SCD admitted to the adult emergency department or hospital or seen in the adult outpatient clinic during calendar years 2000-2009. Charts of all patients seen in the adult multidisciplinary sickle cell clinic were abstracted using prespecified criteria.

Results: Prescribing of hydroxyurea increased from 13% at baseline to 44%. An additional 53% of patients had a documented reason for no prescription. Decreases in admissions, 30-day readmissions, and lengths of stay resulted in an average savings of 458 bed days per year.

Conclusion: Multidisciplinary care for the adult with SCD provided in the context of the chronic care model can result in significant improvements in important quality targets and may reduce acute resource use.