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Mendez GG, Nocek JM, Brambilla DJ, Jacobs S, Cole O, Kanter J, Glassberg J, Saving KL, Melvin CL, Gibson RW, Treadwell M, Jackson GL, King AA, Gordeuk VR, Kroner B, Hsu LL. Social determinants of health and treatment center affiliation: analysis from the sickle cell disease implementation consortium registry. BMC Health Serv Res 2024; 24:291. [PMID: 38448911 PMCID: PMC10916176 DOI: 10.1186/s12913-024-10717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Adults with sickle cell disease (SCD) suffer early mortality and high morbidity. Many are not affiliated with SCD centers, defined as no ambulatory visit with a SCD specialist in 2 years. Negative social determinants of health (SDOH) can impair access to care. HYPOTHESIS Negative SDOH are more likely to be experienced by unaffiliated adults than adults who regularly receive expert SCD care. METHODS Cross-sectional analysis of the SCD Implementation Consortium (SCDIC) Registry, a convenience sample at 8 academic SCD centers in 2017-2019. A Distressed Communities Index (DCI) score was assigned to each registry member's zip code. Insurance status and other barriers to care were self-reported. Most patients were enrolled in the clinic or hospital setting. RESULTS The SCDIC Registry enrolled 288 Unaffiliated and 2110 Affiliated SCD patients, ages 15-45y. The highest DCI quintile accounted for 39% of both Unaffiliated and Affiliated patients. Lack of health insurance was reported by 19% of Unaffiliated versus 7% of Affiliated patients. The most frequently selected barriers to care for both groups were "previous bad experience with the healthcare system" (40%) and "Worry about Cost" (17%). SCD co-morbidities had no straightforward trend of association with Unaffiliated status. The 8 sites' results varied. CONCLUSION The DCI economic measure of SDOH was not associated with Unaffiliated status of patients recruited in the health care delivery setting. SCDIC Registrants reside in more distressed communities than other Americans. Other SDOH themes of affordability and negative experiences might contribute to Unaffiliated status. Recruiting Unaffiliated SCD patients to care might benefit from systems adopting value-based patient-centered solutions.
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Grants
- 3U01HL134042-04S2 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- 5U01HL134042-S2 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- NIH
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Affiliation(s)
- Gustavo G Mendez
- University of Illinois Chicago, 840 S. Wood St., MC 856 Pediatrics, 60612, Chicago, IL, USA
| | - Judith M Nocek
- University of Illinois Chicago, 840 S. Wood St., MC 856 Pediatrics, 60612, Chicago, IL, USA
| | | | - Sara Jacobs
- RTI International, Research Triangle Park, USA
| | | | - Julie Kanter
- University of Alabama at Birmingham, Birmingham, USA
| | | | - Kay L Saving
- University of Illinois College of Medicine at Peoria, Peoria, USA
| | | | | | | | - George L Jackson
- Duke University, Durham, USA
- Durham Veterans Affairs Health Care System, Durham, USA
- University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Victor R Gordeuk
- University of Illinois Chicago, 840 S. Wood St., MC 856 Pediatrics, 60612, Chicago, IL, USA
| | | | - Lewis L Hsu
- University of Illinois Chicago, 840 S. Wood St., MC 856 Pediatrics, 60612, Chicago, IL, USA.
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2
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Attell BK, Barrett PM, Pace BS, McLemore ML, McGee BT, Oshe R, DiGirolamo AM, Cohen LL, Snyder AB. Characteristics of Emergency Department Visits Made by Individuals With Sickle Cell Disease in the U.S., 1999-2020. AJPM FOCUS 2024; 3:100158. [PMID: 38149076 PMCID: PMC10749880 DOI: 10.1016/j.focus.2023.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Introduction Individuals living with sickle cell disease experience high levels of morbidity that result in frequent utilization of the emergency department. The objective of this study was to provide updated national estimates of emergency department utilization associated with sickle cell disease in the U.S. Methods Data from the National Hospital Ambulatory Medical Care Survey for the years 1999-2020 were analyzed. Complex survey analysis was utilized to produce national estimates overall and by patient age groups. Results On average, approximately 222,612 emergency department visits occurred annually among individuals with sickle cell disease, a nearly 13% increase from prior estimates. The annual volume of emergency department visits steadily increased over time, and pain remains the most common patient-cited reason for visiting the emergency department. Patient-reported pain levels for individuals with sickle cell disease were high, with 64% of visits associated with severe pain and 21% associated with moderate pain. Public insurance sources continue to cover most visits, with Medicaid paying for 60% of visits and Medicare paying for 12% of visits. The average time spent in the emergency department increased from previous estimates by about an hour, rising to approximately 6 hours. The average wait time to see a provider was 53 minutes. Conclusions Utilization of the emergency department by individuals living with sickle cell disease remains high, especially for pain. With more than half of patients with sickle cell disease reporting severe pain levels, emergency department staff should be prepared to assess and treat sickle cell disease-related pain following evidence-based guidelines and recommendations. The findings of this study can help improve care in this population.
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Affiliation(s)
- Brandon K. Attell
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | | | - Betty S. Pace
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Morgan L. McLemore
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Blake T. McGee
- School of Nursing, Georgia State University, Atlanta, Georgia
| | - Rewo Oshe
- Department of Psychology, College of Arts & Sciences, Georgia State University, Atlanta, Georgia
| | - Ann M. DiGirolamo
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Lindsey L. Cohen
- Department of Psychology, College of Arts & Sciences, Georgia State University, Atlanta, Georgia
| | - Angela B. Snyder
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
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3
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Ilerhunmwuwa NP, Inyang L, Wasifuddin M, Aiwuyo H, Tahir M, Hakobyan N, Ankah P, Torere BE, Amaechi UM, Rayapureddy AK, Wang JC. Demographics and outcomes of hemoglobin genotype in hospitalized patients with COVID-19 and sickle cell disease in the United States. Eur J Haematol 2023; 111:611-619. [PMID: 37477175 DOI: 10.1111/ejh.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is associated with poor outcomes in sickle cell disease (SCD) patients. However, there is a paucity of data comparing hemoglobin (Hb) genotypes in SCD and infection outcomes. METHODS The National Inpatient Sample was used to identify the record of hospitalizations with COVID-19 and SCD in 2020 using the International Classification of Disease, Tenth Revision codes. Study outcomes (invasive mechanical ventilation, extracorporeal membrane oxygenation, shock, vasopressor use, measures of resource utilization, and in-hospital mortality) were compared between hemoglobin SS, SC, and S-beta thalassemia (Sβ). RESULTS Of the 102 975 COVID-19 hospitalizations with SCD, 87.26% had HbSS, 7.16% had HbSC, and 5.58% had HbSβ. Younger patients were more likely to have HbSS, while older patients were likely to have HbSC and HbSβ. HbSS was more frequent with Blacks, while HbSβ was more prevalent with Whites and Hispanics. Though measures of resource utilization were higher in HbSS, there was no significant difference in in-hospital outcomes between the three genotypes. CONCLUSION There is no difference in COVID-19 outcomes among Hb genotypes in SCD. Further studies are needed to explore the reasons for this observation.
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Affiliation(s)
- Nosakhare Paul Ilerhunmwuwa
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Lawrence Inyang
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Mustafa Wasifuddin
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Henry Aiwuyo
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Muhammad Tahir
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Narek Hakobyan
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Paul Ankah
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Beatrice E Torere
- Department of Internal Medicine, North Mississippi Medical Center, Tupelo, Mississippi, USA
| | - Uchenna M Amaechi
- Department of Internal Medicine, Lagos University Teaching Hospital, Surulere, Nigeria
| | | | - Jen Chin Wang
- Department of Hematology and Oncology, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
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4
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Jiao B, Johnson KM, Ramsey SD, Bender MA, Devine B, Basu A. Long-term survival with sickle cell disease: a nationwide cohort study of Medicare and Medicaid beneficiaries. Blood Adv 2023; 7:3276-3283. [PMID: 36929166 PMCID: PMC10336259 DOI: 10.1182/bloodadvances.2022009202] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/13/2023] [Accepted: 01/31/2023] [Indexed: 03/18/2023] Open
Abstract
To our knowledge, we report the first population-based period life table, the expected lifetime survival for Medicare and Medicaid beneficiaries with sickle cell disease (SCD), and the disparities in survival by insurance types in the United States. We constructed a retrospective cohort of individuals with diagnosed SCD receiving common care (any real-world patterns of care except transplant) based on nationwide Medicare and Medicaid claim data (2008-2016), covering beneficiaries in all 50 states. We analyzed lifetime survival probabilities using Kaplan-Meier curves and projected life expectancies at various ages for all, stratified by sex and insurance types. Our analysis included 94 616 individuals with SCD that have not undergone any transplant. Life expectancy at birth was 52.6 years (95% confidence interval: 51.9-53.4). Compared with the adults covered by Medicaid only, those covered by Medicare for disabilities or end-stage renal disease and those dually insured by Medicare and Medicaid had significantly worse life expectancy. Similarly, for beneficiaries aged ≥65 years, these 2 insurance types were associated with significantly shorter life expectancy than those enrolled in Medicare old age and survivor's insurance. Our study underscores the persistent life expectancy shortfall for patients with SCD, the burden of premature mortality during adulthood, and survival disparities by insurance status.
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Affiliation(s)
- Boshen Jiao
- Department of Pharmacy, The Comparative Health Outcomes, Policy & Economics Institute, University of Washington, Seattle, WA
| | - Kate M. Johnson
- Department of Pharmacy, The Comparative Health Outcomes, Policy & Economics Institute, University of Washington, Seattle, WA
- Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Scott D. Ramsey
- Department of Pharmacy, The Comparative Health Outcomes, Policy & Economics Institute, University of Washington, Seattle, WA
- Division of Public Health Sciences and Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - M. A. Bender
- Department of Pediatrics, University of Washington, and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Beth Devine
- Department of Pharmacy, The Comparative Health Outcomes, Policy & Economics Institute, University of Washington, Seattle, WA
- Department of Health Services, University of Washington, Seattle, WA
| | - Anirban Basu
- Department of Pharmacy, The Comparative Health Outcomes, Policy & Economics Institute, University of Washington, Seattle, WA
- Department of Health Services, University of Washington, Seattle, WA
- Department of Economics, University of Washington, Seattle, WA
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5
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Peprah E, Gyamfi J, Lee JT, Islam F, Opeyemi J, Tampubolon S, Ojo T, Qiao W, Mai A, Wang C, Vieira D, Meda S, Adenikinju D, Osei-Tutu N, Ryan N, Ogedegbe G. Analysis of the 2007-2018 National Health Interview Survey (NHIS): Examining Neurological Complications among Children with Sickle Cell Disease in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6137. [PMID: 37372724 DOI: 10.3390/ijerph20126137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
This study compared neurological complications among a national sample of United States children with or without sickle cell disease (SCD) and evaluated health status, healthcare and special education utilization patterns, barriers to care, and association of SCD status and demographics/socioeconomic status (SES) on comorbidities and healthcare utilization. Data was acquired from the National Health Interview Survey (NHIS) Sample Child Core questionnaire 2007-2018 dataset that included 133,542 children. An affirmation from the guardian of the child determined the presence of SCD. Regression analysis was used to compare the associations between SCD and demographics/SES on neurological conditions at p < 0.05. Furthermore, adjusted odds ratios (AORs) were estimated for having various neurological conditions. Of the 133,481 children included in the NHIS, the mean age was 8.5 years (SD: 0.02) and 215 had SCD. Of the children with SCD, the sample composition included male (n = 110), and Black (n = 82%). The SCD sample had higher odds of having neuro-developmental conditions (p < 0.1). Families of Black children (55% weighted) reported household incomes < 100% of federal poverty level. Black children were more likely to experience longer wait times to see the doctor (AOR, 0.3; CI 0.1-1.1). Compared to children without SCD, those with SCD had a greater chance of seeing a medical specialist within 12 months (AOR 2.3; CI 1.5-3.7). This representative sample of US children with SCD shows higher odds of developing neurological complications, increased healthcare and special education services utilization, with Black children experiencing a disproportionate burden. This creates the urgency to address the health burden for children with SCD by implementing interventions in healthcare and increasing education assistance programs to combat neurocognitive impairments, especially among Black children.
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Affiliation(s)
- Emmanuel Peprah
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Joyce Gyamfi
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Justin Tyler Lee
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Farha Islam
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Jumoke Opeyemi
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Siphra Tampubolon
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Temitope Ojo
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Wanqiu Qiao
- Department of Biostatistics, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Andi Mai
- Department of Biostatistics, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Cong Wang
- Department of Biostatistics, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Dorice Vieira
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
- NYU Health Sciences Library, 577 First Avenue, New York, NY 10016, USA
| | - Shreya Meda
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Deborah Adenikinju
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Nana Osei-Tutu
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Nessa Ryan
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, New York, NY 10016, USA
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Gyamfi J, Tampubolon S, Lee JT, Islam F, Ojo T, Opeyemi J, Qiao W, Mai A, Wang C, Vieira D, Ryan N, Osei-Tutu NH, Adenikinju D, Meda S, Ogedegbe G, Peprah E. Characterisation of medical conditions of children with sickle cell disease in the USA: findings from the 2007-2018 National Health Interview Survey (NHIS). BMJ Open 2023; 13:e069075. [PMID: 36854589 PMCID: PMC9980332 DOI: 10.1136/bmjopen-2022-069075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES We used the National Health Interview Survey (NHIS) data set to examine the prevalence of comorbid medical conditions; explore barriers to accessing healthcare and special educational services; and assess the associations between sickle cell disease (SCD) status and demographics/socioeconomic status (SES), and social determinants of health (SDoH) on comorbidities among children in the USA. DESIGN Cross-sectional. SETTING NHIS Sample Child Core questionnaire 2007-2018 data set. PARTICIPANTS 133 481 children; presence of SCD was determined by an affirmative response from the adult or guardian of the child. MAIN OUTCOME MEASURES Multivariate logistic regression was used to compare the associations between SCD status, SES and SDoH for various medical conditions for all races and separately for black children at p<0.05. RESULTS 133 481 children (mean age 8.5 years, SD: 0.02), 215 had SCD and ~82% (weighted) of the children with SCD are black. Children with SCD were more likely to suffer from comorbid conditions, that is, anaemia (adjusted OR: 27.1, p<0.001). Furthermore, children with SCD had at least two or more emergency room (ER) visits (p<0.001) and were more likely to have seen a doctor 1-15 times per year (p<0.05) compared with children without SCD. Household income (p<0.001) and maternal education were lower for children with SCD compared with children without SCD (52.4% vs 63.5% (p<0.05)). SCD children with a maternal parent who has < / > High School degree were less likely to have no ER visits or 4-5 ER visits, and more likely to have 2-3 ER visits within 12 months. CONCLUSION Children with SCD experienced significant comorbid conditions and have high healthcare usage, with black children being disproportionately affected. Moreover, maternal education status and poverty level illustrates how impactful SES can be on healthcare seeking behaviour for the SCD population. SDoH have significant implications for managing paediatric patients with SCD in clinical settings.
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Affiliation(s)
- Joyce Gyamfi
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
| | - Siphra Tampubolon
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
| | - Justin Tyler Lee
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
| | - Farha Islam
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
| | - Temitope Ojo
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
| | - Jumoke Opeyemi
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
| | - Wanqiu Qiao
- Department of Biostatistics, New York University, New York, New York, USA
| | - Andi Mai
- Department of Biostatistics, New York University, New York, New York, USA
| | - Cong Wang
- Department of Biostatistics, New York University, New York, New York, USA
| | - Dorice Vieira
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
- Medical Library Services, New York University School of Medicine, New York, New York, USA
| | - Nessa Ryan
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
| | - Nana H Osei-Tutu
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
| | - Deborah Adenikinju
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
| | - Shreya Meda
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity (IEHE), New York University Grossman School of Medicine, New York, New York, USA
| | - Emmanuel Peprah
- School of Global Public Health, Department of Social and Behavioral Sciences, ISEE Lab, New York University, New York, New York, USA
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7
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Adigwe OP. Access to healthcare for people with sickle cell disease: Views of healthcare professionals on policies and practices. Mol Genet Genomic Med 2023; 11:e2142. [PMID: 36727575 PMCID: PMC10178791 DOI: 10.1002/mgg3.2142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Sickle cell disease is a genetic disorder with its highest prevalence in Nigeria. The condition causes red blood cells to turn rigid, and consequently, results to several complications including organ damage. This study aimed at assessing views of health practitioners in Nigeria on policies and practices in the area of access to healthcare services for sickle cell disease. METHODS A cross-sectional study was undertaken amongst healthcare professionals in Nigeria. Data were collected using a self-administered questionnaire, and analyses were undertaken using Statistical Package for Social Sciences software. RESULTS A significant proportion of the participants (42.8%) disagreed that relevant legislative framework exists to facilitate optimal access to high-quality healthcare services for persons with sickle cell disorder in Nigeria. Two-thirds of the study cohort were of the opinion that public health surveillance towards sickle cell disease was suboptimal (61.2%). Also, more than three-quarters of the respondents (78.7%) indicated that the cost of managing sickle cell disease was not affordable to majority of affected Nigerians. CONCLUSION This study provides critical insights into access to healthcare services for sickle cell disease. As such, challenges preventing access to healthcare services for sickle cell patients which have been identified in this study can underpin the development of contextual policies to address them.
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Affiliation(s)
- Obi Peter Adigwe
- National Institute for Pharmaceutical Research and Development, Abuja, Nigeria
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Khan H, Krull M, Hankins JS, Wang WC, Porter JS. Sickle cell disease and social determinants of health: A scoping review. Pediatr Blood Cancer 2023; 70:e30089. [PMID: 36495544 PMCID: PMC9790038 DOI: 10.1002/pbc.30089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
Social determinants of health (SDoH) may impact outcomes in sickle cell disease (SCD). We conducted a comprehensive literature review of five electronic databases to elucidate the relationship between SDoH and SCD, and identify gaps in the literature. Our search yielded 59 articles, which we organized into five SDoH areas: Neighborhood and Built Environment, Health and Healthcare, Social and Community Context, Education, and Economic Stability. We found that social determinants, such as access to healthcare, were inconsistently evaluated. Improved recognition and understanding of SDoH should enhance the development of programs that directly address its detrimental effects on patients with SCD.
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Affiliation(s)
- Hamda Khan
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Mathew Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Winfred C. Wang
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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Hankins JS, Potter MB, Fernandez ME, Melvin C, DiMartino L, Jacobs SR, Bosworth HB, King AA, Simon J, Glassberg JA, Kutlar A, Gordeuk VR, Shah N, Baumann AA, Klesges LM. Evaluating the implementation of a multi-level mHealth study to improve hydroxyurea utilization in sickle cell disease. FRONTIERS IN HEALTH SERVICES 2023; 2:1024541. [PMID: 36925803 PMCID: PMC10012741 DOI: 10.3389/frhs.2022.1024541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/09/2022] [Indexed: 01/22/2023]
Abstract
Background Sickle Cell Disease (SCD) is a progressive genetic disease that causes organ damage and reduces longevity. Hydroxyurea is an underutilized evidence-based medication that reduces complications and improves survival in SCD. In a multi-site clinical trial, part of the NIH-funded Sickle Cell Disease Implementation Consortium (SCDIC), we evaluate the implementation of a multi-level and multi-component mobile health (mHealth) patient and provider intervention to target the determinants and context of low hydroxyurea use. Given the complexity of the intervention and contextual variability in its implementation, we combined different behavioral and implementation theories, models, and frameworks to facilitate the evaluation of the intervention implementation. In this report, we describe engagement with stakeholders, planning of the implementation process, and final analytical plan to evaluate the implementation outcomes. Methods During 19 meetings, a 16-member multidisciplinary SCDIC implementation team created, conceived, and implemented a project that utilized Intervention Mapping to guide designing an intervention and its evaluation plan. The process included five steps: (1) needs assessment of low hydroxyurea utilization, (2) conceptual framework development, (3) intervention design process, (4) selection of models and frameworks, and (5) designing evaluation of the intervention implementation. Results Behavioral theories guided the needs assessment and the design of the multi-level mHealth intervention. In designing the evaluation approach, we combined two implementation frameworks to best account for the contextual complexity at the organizational, provider, and patient levels: (1) the Consolidated Framework for Implementation Research (CFIR) that details barriers and facilitators to implementing the mHealth intervention at multiple levels (users, organization, intervention characteristics, broader community), and (2) the Technology Acceptance Model (TAM), a conceptual model specific for explaining the intent to use new information technology (including mHealth). The Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework was used to measure the outcomes. Discussion Our research project can serve as a case study of a potential approach to combining different models/frameworks to help organize and plan the evaluation of interventions to increase medication adherence. The description of our process may serve as a blueprint for future studies developing and testing new strategies to foster evidence-based treatments for individuals living with SCD.
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Affiliation(s)
- J. S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - M. B Potter
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA, United States
- Clinical, Family, and Community Medicine, University of California San Francisco, CA, United States
| | - M. E Fernandez
- Health Promotion and Behavioral Sciences, University of Texas Health Science Center, School of Public Health at Houston, Houston, TX, United States
| | - C Melvin
- The Medical University of South Carolina, Charleston, SC, United States
| | - L DiMartino
- RTI International, Research triangle park, NC, United States
| | - S. R Jacobs
- RTI International, Research triangle park, NC, United States
| | - H. B Bosworth
- Department of Population Health Studies, Duke University, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - A. A King
- Department of Pediatrics, Washington University, Saint louis, MO, United States
| | - J Simon
- Department of Emergency Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - J. A Glassberg
- Department of Emergency Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - A Kutlar
- Augusta University, Augusta, GA, United States
| | - V. R Gordeuk
- Department of Medicine, the University of Illinois at Chicago, Chicago, IL, United States
| | - N Shah
- Department of Pediatric Hematology and Oncology, Duke University, Durham, NC, United States
| | - A. A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint louis, MO, United States
| | - L. M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint louis, MO, United States
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Phan V, Park JA, Dulman R, Lewis A, Briere N, Notarangelo B, Yang E. Ten-year Longitudinal Analysis of Hydroxyurea Implementation in a Pediatric Sickle Cell Program. Eur J Haematol 2022; 109:465-473. [PMID: 35811388 DOI: 10.1111/ejh.13827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022]
Abstract
Hydroxyurea (HU) has proven benefit in sickle cell anemia (SCA), but HU is still underutilized. The Pediatric Sickle Cell Program of Northern Virginia prescribes HU regardless of symptoms to all SCA patients age ≥ 9 months and prospectively tracks outcomes. HU is dosed to maximum tolerated dosing (MTD), targeting 30% Hgb F. Longitudinal data from 2009-2019 encompassing 1222 HU-eligible and 950 HU-exposure patient-years were analyzed in 2-year intervals for hemoglobin (Hgb), fetal hemoglobin (Hgb F), hospitalizations, transfusions, and treat-and-release ED visits. Comparing HU-eligible patients in the interval prior to HU implementation (2009-2011) to the last interval analyzed after HU implementation (2017-2019), HU usage increased from 33% to 93%, average Hgb increased from 8.3±0.98 to 9.8±1.3 g/dL (p<0.0001), average Hgb F rose from 13±8.7% to 26±9.9% (p<0.0001), hospitalizations decreased from 0.71 (95% CI 0.54-0.91) to 0.2 (95% CI 0.13-0.28) admissions/person-year, sporadic transfusions decreased from 0.4 (95% CI 0.27-0.55) to 0.05 (95% CI 0.02-0.12) transfusions/person-year. Treat-and-release ED visit rates remained unchanged, varying between 0.49 (95% CI 0.36-0.64) and 0.64 (95% CI 0.48-0.83) visits/person-year. By the last interval, 72% of patients had Hgb ≥ 9g/dL, 42% had Hgb F ≥ 30%, 79% experienced no hospitalizations, and 94% received no transfusions. Uniform HU prescription for SCA patients with close monitoring to achieve high Hgb F resulted in significant improvements in laboratory and clinical outcomes within 2 years, which continued to improve over the next 6 years. Rigorous HU implementation in a pediatric sickle cell population is feasible, effective, and sustainable. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Vivian Phan
- Pediatric Specialists of Virginia, Fairfax, VA
| | - Ju Ae Park
- Inova Fairfax Hospital, Falls Church, VA
| | | | | | | | | | - Elizabeth Yang
- Pediatric Specialists of Virginia, Fairfax, VA.,Department of Pediatrics, George Washington University School of Medicine, Washington, DC
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Hankins JS, Klesges LM. Bridging the implementation gap in medication adherence. If you build it, will they come? Br J Haematol 2021; 196:17-18. [PMID: 34786706 DOI: 10.1111/bjh.17953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | - Lisa M Klesges
- Washington University in St Louis School of Medicine, St Louis, MO, USA
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12
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Kanter J, Meier ER, Hankins JS, Paulukonis ST, Snyder AB. Improving Outcomes for Patients With Sickle Cell Disease in the United States. JAMA HEALTH FORUM 2021; 2:e213467. [DOI: 10.1001/jamahealthforum.2021.3467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Julie Kanter
- Division of Hematology and Oncology, University of Alabama Birmingham, Birmingham
| | | | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Angela B. Snyder
- Georgia Health Policy Center and the Department of Public Management and Policy, Andrew Young School of Policy Studies, Georgia State University, Atlanta
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Grosse SD, Green NS, Reeves SL. Administrative data identify sickle cell disease: A critical review of approaches in U.S. health services research. Pediatr Blood Cancer 2020; 67:e28703. [PMID: 32939942 PMCID: PMC7606824 DOI: 10.1002/pbc.28703] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022]
Abstract
To identify people living with sickle cell disease (SCD) and study their healthcare utilization, researchers can either use clinical records linked to administrative data or use billing diagnosis codes in stand-alone administrative databases. Correct identification of individuals clinically managed for SCD using diagnosis codes in claims databases is limited by the accuracy of billing codes in outpatient encounters. In this critical review, we assess the strengths and limitations of claims-based SCD case-finding algorithms in stand-alone administrative databases that contain both inpatient and outpatient records. Validation studies conducted using clinical records and newborn screening for confirmation of SCD case status have found that algorithms that require three or more nonpharmacy claims or one inpatient claim plus two or more outpatient claims with SCD codes show acceptable accuracy (positive predictive value and sensitivity) in children and adolescents. Future studies might seek to assess the accuracy of case-finding algorithms over the lifespan.
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Affiliation(s)
- Scott D. Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - Nancy S. Green
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | - Sarah L. Reeves
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan,School of Public Health, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
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Raphael JL. Addressing social determinants of health in sickle cell disease: The role of Medicaid policy. Pediatr Blood Cancer 2020; 67:e28202. [PMID: 32037648 DOI: 10.1002/pbc.28202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Jean L Raphael
- Center for Child Health Policy and Advocacy, Baylor College of Medicine, Houston, Texas.,Section of Academic General Pediatrics, Baylor College of Medicine, Houston, Texas
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