Improving Preventive Care for Children With Sickle Cell Anemia: A Quality Improvement Initiative.

Michael D. Cabana, Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, Calif.; Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, Calif.; the Institute for Health Policy Studies, University of California, San Francisco (UCSF), San Francisco, Calif; Children’s Hospital at Montefiore, Bronx, N.Y; The Albert Einstein College of Medicine, Bronx, N.Y.
Anne Marsh, Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, Calif.
Marsha J. Treadwell, UCSF Benioff Children’s Hospital, Oakland, Calif.
Peggy Stemmler, FrameShift Group, Phoenix, Ariz.
Michael Rowland, UCSF Benioff Children’s Hospital, Oakland, Calif.
M A. Bender, Department of Pediatrics, University of Washington, Seattle, Wash.; Seattle Children’s Hospital; Seattle, Wash.
Neha Bhasin, Department of Pediatrics, University of Arizona, Tucson, Ariz.
Jong H. Chung, Department of Pediatrics, University of California, Davis, Sacramento, Calif.
Kathryn Hassell, ∥Department of Internal Medicine, University of Colorado, Aurora, Colo.
N F Nik Abdul Rashid, Cure 4 The Kids Foundation, Las Vegas, Nev.
Trisha E. Wong, Children’s Hospital at Montefiore, Bronx, N.Y.; Departments of Pediatrics and Pathology, Oregon Health & Science University, Portland, Oreg.
Naomi S. Bardach, Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, Calif.; the Institute for Health Policy Studies, University of California, San Francisco (UCSF), San Francisco, Calif.

Document Type

Article

Publication Date

1-1-2021

Abstract

Sickle cell disease is a complex chronic disorder associated with increased morbidity and early mortality. The Pediatric Quality Measures Program has developed new sickle cell-specific quality measures focused on hydroxyurea (HU) counseling and annual transcranial Doppler (TCD) screening; however, these measures have not been used in a clinical setting to inform quality improvement (QI) efforts.

Methods: From 2017 to 2018, 9 sickle cell subspecialty clinics from the Pacific Sickle Cell Regional Collaborative conducted a year-long QI collaborative focused on improving the percentage of patients with HU counseling and TCD screening based on the new quality measures. After an initial kick-off meeting, the 9 sites participated in monthly conference calls. We used run charts annotated with plan-do-study-act cycle activities to track each site's monthly progress and the overall mean percentage for the entire collaborative.

Results: There was an overall improvement in the aggregate HU counseling from 85% to 98% (

Conclusion: Over 1 year, we found that a regional QI collaborative increased HU counseling. Although referral for TCD screening increased, there was no overall change in TCD completion. Overall, this QI report's findings can help clinicians adopt and implement these quality measures to improve outcomes in children.

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