Elsevier

The Journal of Pediatrics

Volume 166, Issue 1, January 2015, Pages 188-190.e1
The Journal of Pediatrics

Clinical and Laboratory Observations
Transcranial Doppler Screening of Medicaid-Insured Children with Sickle Cell Disease

Portions of the study were presented at the Pediatric Academic Societies' meeting, Washington, DC, May 4-7, 2013.
https://doi.org/10.1016/j.jpeds.2014.09.018Get rights and content

Transcranial Doppler screening reduces the risk of stroke in children with sickle cell disease. We tested the effect of informational letters sent to parents and doctors of Medicaid-insured children on improving screening efficiency. The letters did not improve the low baseline screening rates, suggesting the need for more aggressive outreach. Hematologist visits were correlated with increased screening rates.

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Methods

Study data were Maryland Medicaid administrative data for the years 2002-2011. Children were assumed to have SCD if they had ≥1 inpatient visit, or ≥2 outpatient visits >30 days apart, with a primary diagnosis of SCD.9, 13 Children aged 2-16 years during the intervention window and enrolled in a Medicaid managed care organization (MCO) were retained.

Claims from a 1-year baseline period (November 1, 2010, to October 31, 2011) were reviewed for TCD billing codes. Children lacking TCDs were

Results

A total of 829 children met study inclusion criteria; approximately one-fourth received TCD screening during the baseline period (Table I). Unscreened children (n = 571) were eligible for the intervention. Twenty-one subjects received TCD screening during the intervention period and were excluded from subsequent analyses. In the final sample (n = 550), the intervention group was demographically similar to the control group, except intervention subjects were less likely to live in high-density

Discussion

In our study of Medicaid-insured children with SCD, <25% received recommended TCD screening in the preceding year, and <10% of unscreened individuals were screened during follow-up. Parent- and PCP-targeted informational letters had no measurable affect on TCD delivery. Hematologist visits, but not WCC visits, during the follow-up period were associated with TCD delivery, suggesting that the process is likely specialist-driven. The finding that children with a hematologist visit during the

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Supported by the Robert Wood Johnson Foundation Physician Faculty Scholars Program. J.S. and J.C. were supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (K23HL078819 and U54HL090515, respectively). J.C. also was supported by the Maryland Department of Health and Mental Hygiene (FH 865 GEN). The authors declare no conflicts of interest.

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