2. Adherence to NHLBI guidelines for transfusion is low and variable, ranging from 9-66%.

3. After stratification by disease severity, attendings trained in non-pediatric specialties are still less likely to transfuse in CH than in non-CH. This suggests that institutional factors affect differences in guideline adherence.

4. More research is needed to explore how the relationship between hospital type and attending specialty influences care and patient outcomes.

5. Context. It is unknown if the management of sickle cell disease (SCD) in adolescent/young adults (A/YA) differs among specialists in child- and adult-centered hospitals.

6. Objective. To determine if transfusion for inpatients aged 16-25 yrs with SCD and acute chest syndrome (ACS), as recommended by NHLBI, is associated with physician specialty and care in a children’s hospital (CH) or non-CH.

7. Design, Setting, and Patients. Retrospective cohort of 2,221 hospital admissions in 2007-2009 of patients aged 16-25 yrs with SCD and ACS. Data was abstracted from a national hospital-based clinical and financial database.

8. Outcome. Simple or exchange transfusion

9. Results.Attending physicians who designate their specialties as adult hematology/oncology (H/O), family medicine (FM), and other are less likely to transfuse A/YA’s with SCD and ACS admitted to CH than non-CH. Across all hospital types and specialties, less than two-thirds of patients receive recommended transfusion.

10. Retrospective cohort of 2,221 hospital admissions from 1/1/07-12/31/09 of patients aged 16-25 yrs with SCD and ACS.

11. Data source: Premier Perspective, a national clinical and financial database of >600 hospitals

12. Hospitals were categorized as CH or non-CH using definitions established by NACHRI.

13. Outcome: Simple or exchange transfusion

15. NHLBI guidelines recommend simple or exchange transfusion for treatment of ACS.

17. Imperfect measure of case-mix

18. Few CH overall; only 1 free-standing CH

19. Unknown if poor adherence to NHLBI guidelines associated with clinical outcomeObjectives To determine if transfusion for inpatients aged 16-25 yrs with SCD and ACS is associated with physician specialty and care in a CH or non-CH. Adolescents and young adults with sickle cell disease: Do hospital type and provider specialty matter? Sophia Jan, MD; Gail Slap, MD, MS; Kimberly Smith-Whitley, MD;Ron Keren, MD, MPH; David Rubin, MD, MSCE RWJF Clinical Scholars Program, Departments of Pediatrics and Medicine, Leonard Davis Institute of Health Economics, Center for Clinical Epidemiology and Biostatistics; University of Pennsylvania Figure 1:AOR* of transfusion by hospital type Figure 2: AOR* of transfusion by attending specialty Figure 3: Reduction in transfusion probability when providers are in CH compared to NCH