Preventive treatments are known to prevent major complications associated with sickle cell disease, including pneumococcal infection and stroke. However, many young children are not receiving these effective preventive measures, according to a study published in the July sickle cell-focused supplement to the American Journal of Preventive Medicine.
Comprehensive care that incorporates simple preventive measures like a pneumococcal polysaccharide vaccine (PPV) and transcranial Doppler ultrasound (TCD) starting at age 2 years can prevent major sickle cell-related complications. For this study the researchers analyzed data for 125 publicly insured children (aged 24 to 36 months between Jan. 1, 2004, and Dec. 31, 2008) with sickle cell anemia. Only 36.0 percent of children had documentation of both PPV and TCD, while 15.2 percent of children received neither intervention. Of the 48.8 percent of children receiving only one intervention, kids were more likely to have had a PPV (77.0 percent) than a TCD (23.0 percent).
In addition to finding “suboptimal” adherence to the standard of care, the researchers found that there is no single, reliable data source for tracking standard of care for children with sickle cell anemia statewide. To complete this study, the researchers used claims data from Medicaid and the Children’s Health Insurance Program, medical record review, and the Georgia Registry of Immunization Transaction and Services (GRITS) data. GRITS was the best source of information for tracking vaccinations and the claims data was equally comprehensive in monitoring receipt of TCD. Both of these data sources should be considered by those developing additional prevention metrics. The Georgia Health Policy Center is compiling this data, in partnership with the Georgia Department of Public Health, as part of a pilot statewide surveillance system established through the Registry and Surveillance for Hemoglobinopathies (RuSH) project.
“Developing and testing care metrics is the first step in improving quality of care for individuals with chronic diseases like SCD,” says study co-author Angela Snyder, Ph.D., associate project director at the Georgia Health Policy Center. “These population-based prevention metrics for sickle cell disease are important for health systems, clinics, and individual practices as the U.S. healthcare system moves to population-based financing models.”
The original RuSH project was funded by the U.S. Centers for Disease Control and Prevention.
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