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Creary S, Reeves S. Assessing the Quality of Care for Children With Sickle Cell Anemia: We Are Still Failing. Pediatrics 2024; 153:e2023064284. [PMID: 38444351 DOI: 10.1542/peds.2023-064284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Susan Creary
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Sarah Reeves
- Department of Pediatrics, Susan B Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan
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Anderson AT, Mack WJ, Horiuchi SS, Paulukonis S, Zhou M, Snyder AB, Doctor JN, Kipke M, Coates T, Freed G. National Quality Indicators in Pediatric Sickle Cell Anemia. Pediatrics 2024; 153:e2022060804. [PMID: 38444343 PMCID: PMC10982541 DOI: 10.1542/peds.2022-060804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To assess nationally endorsed claims-based quality measures in pediatric sickle cell anemia (SCA). METHODS Using data from the Sickle Cell Data Collection programs in California and Georgia from 2010 to 2019, we evaluated 2 quality measures in individuals with hemoglobin S/S or S/β-zero thalassemia: (1) the proportion of patients aged 3 months to 5 years who were dispensed antibiotic prophylaxis for at least 300 days within each measurement year and (2) the proportion of patients aged 2 to 15 years who received at least 1 transcranial Doppler ultrasound (TCD) within each measurement year. We then evaluated differences by year and tested whether performance on quality measures differed according to demographic and clinical factors. RESULTS Only 22.2% of those in California and 15.5% in Georgia met or exceeded the quality measure for antibiotic prophylaxis, with increased odds associated with rural residence in Georgia (odds ratio 1.61; 95% confidence interval 1.21-2.14) compared with urban residence and a trend toward increased odds associated with a pediatric hematologist prescriber (odds ratio 1.28; 95% confidence interval 0.97, 1.69) compared with a general pediatrician. Approximately one-half of the sample received an annual assessment of stroke risk using TCD (47.4% in California and 52.7% in Georgia), with increased odds each additional year in both states and among younger children. CONCLUSIONS The rates of receipt of recommended antibiotic prophylaxis and annual TCD were low in this sample of children with SCA. These evidence-based quality measures can be tracked over time to help identify policies and practices that maximize survival in SCA.
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Affiliation(s)
- Ashaunta T. Anderson
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Wendy J. Mack
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | | | - Mei Zhou
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Angela B. Snyder
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Jason N. Doctor
- Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, Los Angeles, California
| | - Michele Kipke
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Thomas Coates
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Gary Freed
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
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Reeves SL, Horiuchi S, Zhou M, Paulukonis S, Snyder A, Wilson-Frederick S, Hulihan M. Case Ascertainment of Sickle Cell Disease Using Surveillance or Single Administrative Database Case Definitions. Public Health Rep 2024; 139:187-194. [PMID: 37204194 PMCID: PMC10851905 DOI: 10.1177/00333549231166465] [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] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE In the absence of access to surveillance system data, single-source administrative databases are often used to study health care utilization and health outcomes among people with sickle cell disease (SCD). We compared the case definitions from single-source administrative databases with a surveillance case definition to identify people with SCD. MATERIALS AND METHODS We used data from Sickle Cell Data Collection programs in California and Georgia (2016-2018). The surveillance case definition for SCD developed for the Sickle Cell Data Collection programs uses multiple databases, including newborn screening, discharge databases, state Medicaid programs, vital records, and clinic data. Case definitions for SCD in single-source administrative databases varied by database (Medicaid and discharge) and years of data (1, 2, and 3 years). We calculated the proportion of people meeting the surveillance case definition for SCD that was captured by each single administrative database case definition for SCD, by birth cohort, sex, and Medicaid enrollment. RESULTS In California, 7117 people met the surveillance case definition of SCD from 2016 through 2018; 48% of this group was captured by the Medicaid case definition and 41% by the discharge case definition. In Georgia, 10 448 people met the surveillance case definition of SCD from 2016 through 2018; 45% of this group was captured by the Medicaid case definition and 51% by the discharge case definition. These proportions differed by years of data, birth cohort, and length of Medicaid enrollment. PRACTICE IMPLICATIONS The surveillance case definition identified twice as many people with SCD as the single-source administrative database definitions during the same period, but trade-offs exist in using single administrative databases for decisions on policy and program expansion for SCD.
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Affiliation(s)
- Sarah L. Reeves
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics and Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sophia Horiuchi
- Tracking California, Public Health Institute, Oakland, CA, USA
| | - Mei Zhou
- Andrew Young School of Policy Studies, Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
| | | | - Angela Snyder
- Andrew Young School of Policy Studies, Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
| | | | - Mary Hulihan
- Epidemiology and Surveillance Branch, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Long KA, Blakey AO, Amaro CM, Eilenberg JS, Brochier A, Garg A, Drainoni ML, Pashankar F, Esrick EB, Kavanagh PL. Bidirectional processes linking social determinants of health and pediatric sickle cell anemia management: A qualitative study. Pediatr Blood Cancer 2023; 70:e30539. [PMID: 37470711 PMCID: PMC10619973 DOI: 10.1002/pbc.30539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Children with sickle cell anemia (SCA) have substantial medical needs and more unmet basic needs than children with other medical conditions. Despite a recent focus on social determinants of health (SDoH), there remains an incomplete understanding of the processes linking SDoH and disease management, particularly for youth with SCA. This study elucidated these processes and identified ways to mitigate deleterious effects of adverse SDoH on SCA management. METHODS Parents/primary caregivers (N = 27) of children with SCA (≤12 years old) participated in semi-structured interviews regarding SCA management and SDoH and completed quantitative measures of basic needs. Qualitative data were systematically coded and analyzed using applied thematic analysis. Quantitative data were presented descriptively. RESULTS Three qualitative themes were identified. First, SCA management is bidirectionally linked with the social environment, whereby challenges of SCA management can hinder basic needs from being met, and unmet basic needs and financial hardship hinder SCA management. Second, due to limited resources, parents/caregivers are faced with difficult choices between prioritizing basic needs versus SCA management. Third, addressing material, emotional, and informational needs may improve SCA management. Quantitatively, 73% of families endorsed ≥1 basic need, including food insecurity (42%), housing instability (62%), and/or energy insecurity 19% (vs. 20%). CONCLUSION Despite documented associations, there remains a poor understanding of the processes linking SDoH and health. Findings underscore how day-to-day conditions undermine the management of SCA treatments, symptoms, and complications, limiting treatment effectiveness. Understanding these processes may inform family-centered, health equity interventions and policies to improve living conditions, disease management, and health outcomes.
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Affiliation(s)
- Kristin A Long
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Ariel O Blakey
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Christina M Amaro
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Jenna S Eilenberg
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Annelise Brochier
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, UMass Memorial Children's Medical Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Farzana Pashankar
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Erica B Esrick
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia L Kavanagh
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Runge A, Brazel D, Pakbaz Z. Stroke in sickle cell disease and the promise of recent disease modifying agents. J Neurol Sci 2022; 442:120412. [PMID: 36150233 DOI: 10.1016/j.jns.2022.120412] [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: 04/19/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 10/31/2022]
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy affecting approximately 100,000 individuals in the United States. Cerebrovascular disease is among the most common and debilitating complications of SCA, with 53% experiencing silent cerebral infarct by age 30 and 3.8% experiencing overt stroke by age 40 years. This review highlights the burden of cerebrovascular disease in SCD, including both stroke and silent cerebral infarct (SCI). We then discuss the pathophysiology of stroke and cerebral fat embolism in the absence of a patent foramen ovale. This review also reveals that options for primary and secondary stroke prevention in SCD are still limited to hydroxyurea and blood transfusion, and that the role of aspirin and anticoagulation in SCD stroke has not been adequately studied. Limited data suggest that the novel disease-modifying agents for SCD management may improve renal dysfunction, leg ulcers, and lower the abnormally high TCD flow velocity. Further research is urgently needed to investigate their role in stroke prevention in SCD, as these novel agents target the main stroke contributors in SCD - hemolysis and vaso-occlusion. This literature review also explores the role of healthcare disparities in slowing progress in SCD management and research in the United States, highlighting the need for more investment in patient and clinician education, SCD management, and research.
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Affiliation(s)
- Ava Runge
- University of California Irvine School of Medicine, CA, USA
| | - Danielle Brazel
- University of California Irvine Medical Center, Department of Medicine, Orange California, CA, USA
| | - Zahra Pakbaz
- University of California Irvine School of Medicine, CA, USA; University of California Irvine Medical Center, Department of Medicine, Orange California, CA, USA; University of California Irvine Medical Center, Division of Hematology Oncology, CA, USA.
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Abstract
IMPORTANCE Sickle cell disease (SCD) is an inherited disorder of hemoglobin, characterized by formation of long chains of hemoglobin when deoxygenated within capillary beds, resulting in sickle-shaped red blood cells, progressive multiorgan damage, and increased mortality. An estimated 300 000 infants are born annually worldwide with SCD. Most individuals with SCD live in sub-Saharan Africa, India, the Mediterranean, and Middle East; approximately 100 000 individuals with SCD live in the US. OBSERVATIONS SCD is diagnosed through newborn screening programs, where available, or when patients present with unexplained severe atraumatic pain or normocytic anemia. In SCD, sickling and hemolysis of red blood cells result in vaso-occlusion with associated ischemia. SCD is characterized by repeated episodes of severe acute pain and acute chest syndrome, and by other complications including stroke, chronic pain, nephropathy, retinopathy, avascular necrosis, priapism, and leg ulcers. In the US, nearly all children with SCD survive to adulthood, but average life expectancy remains 20 years less than the general population, with higher mortality as individuals transition from pediatric to adult-focused health care systems. Until 2017, hydroxyurea, which increases fetal hemoglobin and reduces red blood cell sickling, was the only disease-modifying therapy available for SCD and remains first-line therapy for most individuals with SCD. Three additional therapies, L-glutamine, crizanlizumab, and voxelotor, have been approved as adjunctive or second-line agents. In clinical trials, L-glutamine reduced hospitalization rates by 33% and mean length of stay from 11 to 7 days compared with placebo. Crizanlizumab reduced pain crises from 2.98 to 1.63 per year compared with placebo. Voxelotor increased hemoglobin by at least 1 g/dL, significantly more than placebo (51% vs 7%). Hematopoietic stem cell transplant is the only curative therapy, but it is limited by donor availability, with best results seen in children with a matched sibling donor. While SCD is characterized by acute and chronic pain, patients are not more likely to develop addiction to pain medications than the general population. CONCLUSIONS AND RELEVANCE In the US, approximately 100 000 people have SCD, which is characterized by hemolytic anemia, acute and chronic pain, acute chest syndrome; increased incidence of stroke, nephropathy, and retinopathy; and a life span that is 20 years shorter than the general population. While hydroxyurea is first-line therapy for SCD, L-glutamine, crizanlizumab, and voxelotor have been approved in the US since 2017 as adjunctive or second-line treatments, and hematopoietic stem cell transplant with a matched sibling donor is now standard care for severe disease.
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Affiliation(s)
- Patricia L Kavanagh
- Division of General Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Titilope A Fasipe
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston
| | - Ted Wun
- School of Medicine, Division of Hematology and Oncology, University of California Davis, Sacramento
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Reeves SL, Freed GL, Madden B, Wu M, Miller L, Cogan L, Anders D, Creary SE, McCormick J, Dombkowski KJ. Trends in quality of care among children with sickle cell anemia. Pediatr Blood Cancer 2022; 69:e29446. [PMID: 34854548 PMCID: PMC9367210 DOI: 10.1002/pbc.29446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 02/03/2023]
Abstract
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 (2011-2018). 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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Affiliation(s)
- Sarah L Reeves
- Susan B Meister Child Health Evaluation and Research Center; Department of Pediatrics; University of Michigan; Ann Arbor, MI;,Department of Epidemiology; University of Michigan; Ann Arbor, MI
| | - Gary L Freed
- Susan B Meister Child Health Evaluation and Research Center; Department of Pediatrics; University of Michigan; Ann Arbor, MI
| | - Brian Madden
- Susan B Meister Child Health Evaluation and Research Center; Department of Pediatrics; University of Michigan; Ann Arbor, MI
| | - Meng Wu
- New York State Department of Health; Albany, NY
| | | | | | | | - Susan E Creary
- Department of Pediatrics; Nationwide Children’s; Columbus, OH
| | - Julie McCormick
- Susan B Meister Child Health Evaluation and Research Center; Department of Pediatrics; University of Michigan; Ann Arbor, MI
| | - Kevin J Dombkowski
- Susan B Meister Child Health Evaluation and Research Center; Department of Pediatrics; University of Michigan; Ann Arbor, MI
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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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Zeng L, Wang C, Jiang M, Chen K, Zhong H, Chen Z, Huang L, Li H, Zhang L, Choonara I. Safety of ceftriaxone in paediatrics: a systematic review. Arch Dis Child 2020; 105:981-985. [PMID: 32144089 PMCID: PMC7513262 DOI: 10.1136/archdischild-2019-317950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the safety of ceftriaxone in paediatric patients and systematically evaluate the categories and incidences of adverse drug reactions (ADRs) of ceftriaxone in paediatric patients. METHODS We performed a systematic search in Medline, PubMed, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, International Pharmaceutical Abstracts and bibliographies of relevant articles up to December 2018 for all types of studies that assessed the safety of ceftriaxone in paediatric patients aged ≤18 years. RESULTS 112 studies met the inclusion criteria involving 5717 paediatric patients who received ceftriaxone and reported 1136 ADRs. The most frequent ADRs reported in prospective studies were gastrointestinal (GI) disorders (37.4 %, 292/780), followed by hepatobiliary disorders (24.6%, 192/780). Serious ADRs leading to withdrawal or discontinuation of ceftriaxone were reported in 86 paediatric patients. Immune haemolytic anaemia (34.9%, 30/86) and biliary pseudolithiasis (26.7%, 23/86) were the two major causes. Haemolytic anaemia following intravenous ceftriaxone led to death in 11 children whose primary disease was sickle cell disease. Almost all biliary pseudolithiasis are reversible. However, the incidence was high affecting one in five paediatric patients (20.7%). CONCLUSIONS GI ADRs are the most common toxicity of ceftriaxone in paediatric patients. Immune haemolytic anaemia and biliary pseudolithiasis are the most serious ADRs and the major reasons for discontinuation of ceftriaxone. Immune haemolytic anaemia is more likely in children with sickle cell disease and may cause death. Ceftriaxone should be used with caution in children with sickle cell disease. TRIAL REGISTRATION NUMBER CRD42017055428.
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Affiliation(s)
- Linan Zeng
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Chao Wang
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin, China
| | - Min Jiang
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Kexin Chen
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Haiqin Zhong
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Zhe Chen
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Liang Huang
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Hailong Li
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China .,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Imti Choonara
- Academic Division of Child Health, Derbyshire Childrens Hospital, Derby, UK
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Gondhi JP, Dombkowski KJ, Scott EL, Reeves SL. The Impact of Sickle Cell Anemia and Mental Health Diagnoses on Healthcare Use and Preventive Care among Children Enrolled in Medicaid, 2005-2012. J Pediatr 2020; 224:79-86.e2. [PMID: 32446724 DOI: 10.1016/j.jpeds.2020.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine mental health diagnoses, healthcare use, and receipt of age-appropriate preventive care, including antibiotic prophylaxis, hydroxyurea therapy, and transcranial Doppler screenings, among children with sickle cell anemia (SCA). STUDY DESIGN Children aged 1-17 years with SCA from 6 states having 3 or more Medicaid claims with a SCA diagnosis within a year (2005-2012) were included. Children with mental health diagnoses were identified with 1 or more mental health encounters. Poisson and logistic regression models with general estimating equations assessed the relationship between mental health diagnoses, healthcare use, and receipt of age-appropriate preventive care. RESULTS In total, 7963 children with SCA were identified (22 424 person-years); 1593 person-years (7.1%) included 1 or more mental health diagnoses. Children with a mental health diagnosis were more likely to have inpatient admissions (incidence rate ratio [IRR] 1.46, 95% CI 1.36-1.56) and outpatient (IRR 1.27, 95% CI 1.21-1.34), emergency department (IRR 1.39, 95% CI 1.30-1.48), and well-child visits (IRR 1.19, 95% CI 1.11-1.29). Those with a mental health diagnosis were more likely to receive hydroxyurea therapy (odds ration [OR] 1.17, 95% CI 1.03-1.33) and less likely to receive transcranial Doppler screenings (OR 0.79, 95% CI 0.68-0.93). CONCLUSIONS Children with SCA do not receive adequate age-appropriate preventive care. Further research is necessary to identify key points of coordination between mental health and SCA services throughout the life course. This approach may help to increase receipt of age-appropriate preventive care and decrease reliance on acute care.
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Affiliation(s)
- Jennifer P Gondhi
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI.
| | - Kevin J Dombkowski
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI
| | - Eric L Scott
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI; Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Sarah L Reeves
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI; Department of Epidemiology, University of Michigan, Ann Arbor, MI
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Health outcomes and services in children with sickle cell trait, sickle cell anemia, and normal hemoglobin. Blood Adv 2020; 3:1574-1580. [PMID: 31101648 DOI: 10.1182/bloodadvances.2018028043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/12/2019] [Indexed: 01/09/2023] Open
Abstract
The health effects of sickle cell trait among children are unknown. We compared select health outcomes and health services utilization among children with sickle cell trait, sickle cell anemia (SCA), and normal hemoglobin. Newborn screening records were used to identify children with sickle cell trait and SCA born in Michigan (1997-2014) who were enrolled in Michigan Medicaid for ≥1 year from 2012 to 2014. Each select health outcome (acute otitis media, acute respiratory infections, fever, invasive pneumococcal disease, pneumonia and influenza, renal complications, spleen problems, stroke) was defined as ≥1 claim with a diagnosis code for the respective outcome within a study year. Health services utilization was summarized as counts of emergency department, inpatient, and outpatient encounters. The relationship between hemoglobin status and each health outcome or utilization was assessed by logistic or negative binomial regression with generalized estimating equations. The study population consisted of 18 257 children with sickle cell trait, 368 with SCA, and 74 523 with normal hemoglobin (227 188 total person-years). Compared with those with normal hemoglobin, children with sickle cell trait had lower odds of acute otitis media (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.84-0.91), acute respiratory infections (OR, 0.94; 95% CI, 0.92-0.97), pneumonia and influenza (OR, 0.93; 95% CI, 0.87-0.99), and outpatient visits (incidence rate ratio, 0.95; 95% CI, 0.93-0.97). Children with SCA had higher or nonsignificant odds of all outcomes and types of health services utilization. These results indicate that children with sickle cell trait may not be at additional health risk for these outcomes. However, additional case-control studies may be necessary to identify rare events.
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Designing a Multistakeholder Collaboration to Improve Preventive Care for Children With Sickle Cell Anemia. J Pediatr Hematol Oncol 2020; 42:e152-e158. [PMID: 31725546 PMCID: PMC7935462 DOI: 10.1097/mph.0000000000001666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Newly developed measures of health care quality for children with sickle cell anemia (SCA) have revealed significant performance gaps in recommended care. Historically, health systems, Medicaid health plans, and state Medicaid programs have not partnered with patients and families to improve SCA care delivery. We organized 2 novel multistakeholder design meetings to identify potential interventions to deliver high-quality preventive care for children with SCA. Invitees included patients with SCA, families, and representatives from pediatric hematology clinics, Medicaid health plans, community organizations, and a state Medicaid program. Participants identified some barriers to care through presentations and facilitated discussions. Over 35 potential interventions and 6 drivers of high-quality SCA preventive care delivery were organized into a key driver diagram. Many barriers to SCA care delivery could be addressed by Medicaid health plan resources to support members with chronic disease; however, these resources are infrequently used in the pediatric SCA population. Bridging gaps between stakeholder groups identified many potential interventions to improve SCA preventive care delivery at all levels of the health care system. Similar multistakeholder discussions may be useful for other communities interested in improving preventive care for children with SCA or other chronic pediatric diseases.
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McKinney C, Caruso-Brown A, Montgomery K, Gillespie A, Coughlin R, Law D, Brouwer A, Tytler L, Hilden J, Nuss R. A Quality Initiative to Decrease Time to Antibiotics in Children with Sickle Cell Disease and Fever. Pediatr Qual Saf 2020; 5:e245. [PMID: 32190792 PMCID: PMC7056294 DOI: 10.1097/pq9.0000000000000245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/18/2019] [Indexed: 11/25/2022] Open
Abstract
Children with sickle cell disease (SCD) are at increased risk for sepsis secondary to functional asplenia. Timely administration of antibiotics, within 60 minutes of triage, is a national indicator of quality SCD care in the United States. However, there are no reports demonstrating the feasibility of doing so in the outpatient hematology-oncology clinic setting. Local Problem At baseline, in our pediatric hematology-oncology outpatient center, just 10% of children with SCD and fever received timely antibiotics. Methods We implemented a process improvement initiative for children with SCD and fever with the aim of ≥90% receiving timely antibiotics. We enacted interventions focused on general clinic processes from check-in to antibiotics and population-specific interventions, including an intravenous access protocol, notification/communication among staff members, and design of an electronic order set. Results The percentage of children receiving timely antibiotics improved from 10% to 77% with successful maintenance following the interventions. Residual delays are due to nonexpeditious order placement and difficult intravenous access. Conclusion Improving the timely administration of antibiotics in the outpatient hematology-oncology clinic setting for children with SCD and fever is possible. Achieving at least 90% timely antibiotics for children with SCD and fever in the outpatient clinic setting will require ongoing efforts at expeditious order placement and intravenous access.
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Affiliation(s)
- Christopher McKinney
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Amy Caruso-Brown
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Kathleen Montgomery
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Anne Gillespie
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Rebecca Coughlin
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Dawn Law
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Anna Brouwer
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Lauren Tytler
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Joanne Hilden
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Rachelle Nuss
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo.,Colorado Sickle Cell Treatment and Research Center, University of Colorado, Aurora, Colo
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Kimrey S, Saving KL. Sickle Cell Disease: A Primer for Primary Care Providers. Pediatr Ann 2020; 49:e43-e49. [PMID: 31930422 DOI: 10.3928/19382359-20191210-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sickle cell disease is an autosomal recessive disorder with significant global impact. This disorder causes the production of a dysfunctional hemoglobin, which leads to sickling of erythrocytes and ultimately hemolysis, endothelial dysfunction, vaso-occlusion, and sterile inflammation. These cellular level processes produce end-organ changes that ultimately result in specific risks and preventive care needs, unique emergency situations, and long-term complications for patients. Options for the treatment of sickle cell disease are increasing. Thus far, hydroxyurea is the most proven treatment and has been shown to reduce vaso-occlusive crises in children and adults and preserve organ function. Other therapies, both disease modifying and curative, are emerging and will hopefully have a substantial effect in the near future. [Pediatr Ann. 2020;49(1):e43-e49.].
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Kemper AR, Boyle CA, Brosco JP, Grosse SD. Ensuring the Life-Span Benefits of Newborn Screening. Pediatrics 2019; 144:peds.2019-0904. [PMID: 31694980 PMCID: PMC7202673 DOI: 10.1542/peds.2019-0904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alex R. Kemper
- Division of Ambulatory Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Coleen A. Boyle
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey P. Brosco
- Mailman Center for Child Development, Miller School of Medicine, University of Miami, Miami, Florida
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Reeves SL, Jary HK, Gondhi JP, Raphael JL, Lisabeth LD, Dombkowski KJ. Hydroxyurea Initiation Among Children With Sickle Cell Anemia. Clin Pediatr (Phila) 2019; 58:1394-1400. [PMID: 31113236 PMCID: PMC7060659 DOI: 10.1177/0009922819850476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assesses characteristics of children with sickle cell anemia associated with hydroxyurea initiation. Medicaid administrative claims from 6 states (2005-2012) were used to identify children with sickle cell anemia enrolled in Medicaid for ≥2 years. Hydroxyurea use was defined as >30 days' supply of filled prescriptions. Children were classified as initiators (no use in year 1; use in year 2) or nonusers (no use in either year). Logistic regression was used to estimate associations between initiation, health care encounters, and demographics. A total of 4435 children were enrolled for 2 years during the study period; 885 (20.0%) initiators and 3080 (69.4%) nonusers. Children had an annual mean of 2.0 sickle cell disease-related inpatient admissions (SD = 2.2), 8.2 sickle cell disease-related outpatient visits (SD = 7.2), and 3.6 emergency department visits (SD = 3.5). The odds of initiating hydroxyurea increased with increasing health care utilization, age, and calendar year (all P values <.05).
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Affiliation(s)
- Sarah L. Reeves
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
| | - Hannah K. Jary
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
| | - Jennifer P. Gondhi
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
| | - Jean L. Raphael
- Clinical Care Center, Texas Children’s Hospital, Houston, TX
| | | | - Kevin J. Dombkowski
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
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Lee L, Smith-Whitley K, Banks S, Puckrein G. Reducing Health Care Disparities in Sickle Cell Disease: A Review. Public Health Rep 2019; 134:599-607. [PMID: 31600481 DOI: 10.1177/0033354919881438] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited blood disorder most common among African American and Hispanic American persons. The disease can cause substantial, long-term, and costly health problems, including infections, stroke, and kidney failure, many of which can reduce life expectancy. Disparities in receiving health care among African Americans and other racial/ethnic minority groups in the United States are well known and directly related to poor outcomes associated with SCD. As an orphan disease-one that affects <200 000 persons nationwide-SCD does not receive the research funding and pharmaceutical investment directed to other orphan diseases. For example, cystic fibrosis affects fewer than half the number of persons but receives 3.5 times the funding from the National Institutes of Health and 440 times the funding from national foundations. In this review, we discuss the health inequities affecting persons with SCD, describe programs intended to improve their care, and identify actions that could be taken to further reduce these inequities, improve care, control treatment costs, and ease the burden of disease.
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Affiliation(s)
- LaTasha Lee
- Department of Clinical Research & Leadership, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Kim Smith-Whitley
- Comprehensive Sickle Cell Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sonja Banks
- Sickle Cell Disease Association of America, Baltimore, MD, USA
| | - Gary Puckrein
- National Minority Quality Forum, Washington, DC, USA
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Freed GL. A Missed Opportunity to Address a National Shame: The Case of Sickle Cell Disease in the United States. JAMA Pediatr 2019; 173:715-716. [PMID: 31206154 DOI: 10.1001/jamapediatrics.2019.1536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gary L Freed
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor
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