Geographical Effects on Adult Sickle Cell Disease Treatments, Morbidity, and Mortality

Geographical Effects on Adult Sickle Cell Disease Treatments, Morbidity, and Mortality by Paula D. Busbee Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University August 2016 Abstract A small percentage of patients with sickle cell disease (SCD) have experienced an increase in life span by 10 years, while others with the same disease continue to die prematurely. The purpose of the study was to evaluate whether or not regional location was a barrier to care for adults with SCD in relation to emergency department visits and health outcomes at 16 and 21 years after the approval of hydroxyurea therapy as treatment. Secondary data were sourced and a retrospective quantitative correlational design was used to examine the effect of hydroxyurea treatment approval on emergency department visits and mortality (dependent variables) with changes in the regions for Northeast, Midwest, South, and West (independent variables). Insurance status, age, gender, and income level (covariables) were employed to describe the population. ChiSquare analysis was used to examine the association of the variables and sample sizes provided by the HCUP datatsets; Nationwide Inpatient Sample (NIS) 2006 (n=67,214), NIS 2011 (n=80,040), Nationwide Emergency Department Sample (NEDS) 2006 (n=164,698), and NEDS 2011 (n=215,296). The results of the analysis revealed a significant association between regional location, emergency department visits, and deaths among SCD patients. The implications for social change include improvements in health and health outcomes regionally, with adult SCD education for health care providers and patients on SCD treatment protocols. Adults with SCD might possibly benefit from this study with improvements in health and health outcomes for all regions once the barrier to care and specific areas are identified.A small percentage of patients with sickle cell disease (SCD) have experienced an increase in life span by 10 years, while others with the same disease continue to die prematurely. The purpose of the study was to evaluate whether or not regional location was a barrier to care for adults with SCD in relation to emergency department visits and health outcomes at 16 and 21 years after the approval of hydroxyurea therapy as treatment. Secondary data were sourced and a retrospective quantitative correlational design was used to examine the effect of hydroxyurea treatment approval on emergency department visits and mortality (dependent variables) with changes in the regions for Northeast, Midwest, South, and West (independent variables). Insurance status, age, gender, and income level (covariables) were employed to describe the population. ChiSquare analysis was used to examine the association of the variables and sample sizes provided by the HCUP datatsets; Nationwide Inpatient Sample (NIS) 2006 (n=67,214), NIS 2011 (n=80,040), Nationwide Emergency Department Sample (NEDS) 2006 (n=164,698), and NEDS 2011 (n=215,296). The results of the analysis revealed a significant association between regional location, emergency department visits, and deaths among SCD patients. The implications for social change include improvements in health and health outcomes regionally, with adult SCD education for health care providers and patients on SCD treatment protocols. Adults with SCD might possibly benefit from this study with improvements in health and health outcomes for all regions once the barrier to care and specific areas are identified. Geographical Effects on Adult Sickle Cell Disease Treatments, Morbidity, and Mortality by Paula D. Busbee Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University August 2016 Dedication I dedicate this dissertation to my family. My son Byron and daughter Kristie have given unconditional support throughout this journey. To my mother who departed this life over 20 years ago and left instilled in her children the importance of education. Acknowledgments I would like to thank Dr. Carla Riemersma, Dr. Nicoletta Alexander, and Dr. Roland Thorpe Jr. for the advice, recommendations, and support throughout this process. I would like to acknowledge my friends for being there to listen and provide words of encouragement.