Clinical and Laboratory ObservationsTranscranial Doppler Screening of Medicaid-Insured Children with Sickle Cell Disease
Section snippets
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
References (21)
- et al.
Cerebrovascular accidents in sickle cell disease: rates and risk factors
Blood
(1998) - et al.
Sickle cell disease and stroke
Blood
(2009) - et al.
Transcranial Doppler ultrasonography and prophylactic transfusion program is effective in preventing overt stroke in children with sickle cell disease
J Pediatr
(2010) - et al.
From best evidence to best practice: effective implementation of change in patients' care
Lancet
(2003) - et al.
The use of transcranial ultrasonography to predict stroke in sickle cell disease
N Engl J Med
(1992) - et al.
Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography
N Engl J Med
(1998) The management of sickle cell disease
(2002)- et al.
Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association
Stroke
(2011) - et al.
Quality-of-care indicators for children with sickle cell disease
Pediatrics
(2011) - et al.
A critical assessment of transcranial Doppler screening rates in a large pediatric sickle cell center: opportunities to improve healthcare quality
Pediatr Blood Cancer
(2008)
Cited by (0)
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.