Healthcare utilization and expenditures for low income children with sickle cell disease.

BACKGROUND: While multiple studies have examined the healthcare burden of sickle cell disease (SCD) in adults, few have specifically focused on healthcare utilization and expenditures in children. The objective of this study was to characterize the healthcare utilization and costs associated with the care of low-income children with SCD in comparison to other children of similar socioeconomic status. PROCEDURE: For the study period, 2004-2007, we conducted a retrospective, cross-sectional descriptive analysis of administrative claims data from a managed care plan exclusively serving low-income children with Medicaid and the State Children's Health Insurance Plan (SCHIP). Patient demographics, continuity of insurance coverage, healthcare utilization, and expenditures were collected for all children enrolled with SCD and the general population within the health plan for comparison. RESULTS: On average, 27% of members with SCD required inpatient hospitalization and 39% utilized emergency care in a given calendar year. Both values were significantly higher than those of the general health plan population (P < 0.0001). Across the study period, 63% of members with SCD averaged one well child check per year and 10% had a minimum of one outpatient visit per year to a hematologist for comprehensive specialty care. CONCLUSIONS: Low-income children with SCD demonstrate significantly higher healthcare utilization for inpatient care, emergency center care, and home health care compared to children with similar socio-demographic characteristics. A substantial proportion of children with SCD may fail to meet minimum guidelines for outpatient primary and hematology comprehensive care.

Respiratory syncytial virus prevention outreach project.

The objective of the study is to determine whether early identification, outreach, and intervention would increase compliance with palivizumab prophylaxis for respiratory syncytial virus prevention for members of a Texas Medicaid managed care organization. The study cohort was selected from administrative claims data. The observational study period ran from October 1, 2006, to March 31, 2007. Letters, educational materials, and postcards were mailed and outbound telephone calls were placed to qualified members. In addition, letters were sent to primary care providers. Of the 1236 identified members, the 2,238 letters, educational materials, and reminder postcards mailed resulted in 1091 injections to 394 identified members. Only 10% of the 394 members completed their qualified doses as suggested by the guideline. Even with the most intensive outreach, compliance is not highly assured. We must explore other strategies to overcome barriers in this preventive medicine program.