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Navigating the Pain, Psychosocial and Racial Dynamics of Hospitalized Patients with Sickle Cell Disease

Mitchell BL

Hospital readmissions are receiving more attention because of the implications on cost and quality of care. Many researchers and clinicians believe that a substantial number of readmissions are preventable as evidenced by the significant reductions achieved after the Hospital Readmission Reduction Program mandated by the Affordable Care Act. While sickle cell disease is not currently one of the diseases designated for inclusion in the Hospital Readmission Reduction Program, some of the lessons learned addressing hospital structural characteristics and processes of care can be applied to this population.

Acute worsening of chronic pain is the predominant clinical presentation of patients with sickle cell disease to the hospital. Pain and the measurement of pain is subjective and there are no clearly defined objective clinical criteria or biomarkers to validate or refute the presence of acute sickle cell pain crisis. The current epidemic of nonmedical opioid use and medical opioid abuse combined with racial unrest and governmental oversight in the US worsens a wellknown atmosphere of mistrust on the part of both clinicians and patients with sickle cell disease. These dynamics force the need for a paradigm change in management of these patients.