A comment on improving transcranial <scp>D</scp>oppler ultrasonography screening in children with sickle cell anemia

Lewen, Margaret; Kavanagh, Patricia L.; Sobota, Amy

doi:10.1002/ajh.24727

Cited by 2 publications

(2 citation statements)

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“…13,30 These encounters provide opportunities to intervene to improve rates of preventive services. 26,31,32 However, the mechanisms driving these gaps in quality of care within the health care system are largely unknown, which limits the ability to develop and implement impactful interventions. For example, there are several potential steps in the process of obtaining antibiotic prophylaxis for a child with SCA, including (a) having access to a prescriber who is knowledgeable about SCA and the need for prophylactic antibiotics; and (b) obtaining the medication from the pharmacy.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have demonstrated high levels of outpatient service utilization among those eligible for antibiotic prophylaxis and TCD screening; on average, these children experience up to 13 outpatient visits a year 13,30 . These encounters provide opportunities to intervene to improve rates of preventive services 26,31,32 . However, the mechanisms driving these gaps in quality of care within the health care system are largely unknown, which limits the ability to develop and implement impactful interventions.…”

Section: Discussionmentioning

confidence: 99%

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Trends in quality of care among children with sickle cell anemia

Reeves

Freed

Madden

et al. 2021

Pediatric Blood & Cancer

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Introduction:For decades, it has been recommended that children with sickle cell anemia (SCA) receive antibiotic prophylaxis to prevent serious infections and undergo transcranial Doppler (TCD) screening to identify those at highest risk of overt stroke.We assessed recent temporal trends in antibiotic prophylaxis prescription fills and TCD screening among children with SCA using validated quality measures.Procedure: Using validated claims-based definitions, we identified children with SCA who were enrolled in Michigan or New York State (NYS) Medicaid programs (2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). Among recommended age groups, two outcomes were assessed yearly: (a) filling of ≥300 days of antibiotics, and (b) receipt of greater than or equal to one TCD. The proportion of children with each outcome was calculated by state. Temporal trends in each preventive service were assessed using generalized linear models.Results: A total of 1784 children were eligible for antibiotic prophylaxis (Michigan: 384; NYS: 1400), contributing 3322 person-years. Annual rates of filling ≥300 days of antibiotics ranged from 16% to 22% and were similar by state. There was no change in rates of antibiotic filling over time in Michigan (p-value: .10), but there was a decrease in NYS (p-value: .02). A total of 3439 children with SCA were eligible for TCD screening (Michigan: 710; NYS: 2729), contributing 10,012 person-years. Annual rates of TCD screening ranged from 39% to 45%, were similar by state, and did not change over time (p-values >.05). Conclusions: Most children with SCA do not receive recommended antibiotic prophylaxis and/or TCD screening. New, sustainable, and coordinated interventions across preventive services are urgently needed.

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