In a recent study published in the journal Pediatrics, researchers gathered data to evaluate nationally endorsed, claims-based quality measures in pediatric patients with sickle cell anemia (SCA).
The authors wrote, “Children with SCA are at an increased risk of early mortality. Few nationally endorsed measures exist to track the quality of care received by children with SCA.”
The study’s objective was to evaluate nationally endorsed, claims-based quality measures among pediatric patients with SCA and to identify demographic and clinical characteristics (such as age, gender, and provider type) that may assist in developing and utilizing targeted quality improvement efforts.
From 2010 to 2019, the researchers utilized data from the Sickle Cell Data Collection program, a longitudinal, population-based surveillance system, and assessed data from California and Georgia. The researchers evaluated two quality measures in individuals with hemoglobin S/S or S/β-zero thalassemia: 1) the percentage 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 percentage of patients aged 2 to 15 years who received at least one transcranial Doppler ultrasound (TCD) within each measurement year.
After gathering data, the researchers assessed the variances by year and investigated whether performance on quality measures varied according to demographic and clinical factors.
The results revealed that only 22.2% and 15.5% of patients in California and Georgia, respectively, met or exceeded the quality measure for antibiotic prophylaxis, with augmented odds associated with rural residence in Georgia (odds ratio [OR] 1.61; 95% CI, 1.21-2.14) compared with urban residence. The researchers also noted that there was an inclination toward increased odds associated with a pediatric hematologist prescriber (OR 1.28; 95% CI, 0.97, 1.69) compared with a general pediatrician, and an estimated 50% of the sample received an annual assessment of stroke risk employing TCD (47.4% and 52.7% in California and Georgia respectively), with increased odds each additional year in both states and among younger children.
The authors concluded that in the study sample of pediatric patients with SCA, the implementation of the recommended antibiotic prophylaxis and annual TCD were suboptimal and that based on these findings, evidence-based quality measures can be followed over time to assist in recognizing policies and practices that expand survival in patients with SCA.
The authors wrote, “In sum, despite support from high-quality studies and explicit clinical guidelines, many children with SCA do not receive adequate antibiotic prophylaxis or annual screenings for stroke risk. This may reflect gaps in provider knowledge and practice alongside challenges families face accessing care, as evidenced by suboptimal rates of health supervision visits, hematologist visits, and pneumococcal vaccination.”
Finally, the authors added, “The next steps may include further inquiry into statewide approaches to care, focus groups on provider expectations and patient experience, and surveys of general pediatrician knowledge of care in SCA.”
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