National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Children/Adolescents (3)
- Chronic Conditions (3)
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- Emergency Department (1)
- Health Information Technology (HIT) (1)
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- (-) Sickle Cell Disease (5)
- Telehealth (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 5 of 5 Research Studies DisplayedWachnik AA, Welch-Coltrane JL, Adams MCB
A standardized emergency department order set decreases admission rates and in-patient length of stay for adults patients with sickle cell disease.
The purpose of this 3-year prospective analysis study was to assess a quality improvement project to standardize Emergency Department (ED) care for patients presenting with pain associated with sickle cell disease (SCD). IN 2019 the researchers implemented an ED order set in to improve care and provide adequate management of analgesia. The primary outcome was the overall hospital admission rate for patients after the intervention, and the secondary outcome measures included ED disposition, rate of return to the ED within 72 hours, ED pain scores at admission and discharge, ED treatment time, in-patient length of stay, non-opioid medication use, and opioid medication use. The study found an overall 67% reduction in the hospital admission rate after implementation of the order set and a significant decrease in the percentage admission rate month over month. Time to the first non-opioid analgesic decreased by 71 minutes and there was no change in time to the first opioid medication. The rate of return to the ED within 72 hours did not change and the ED elopement rate did not change. There were significant increases in the prescribing of orally administered acetaminophen, celecoxib, and tizanidine, and intravenous ketamine and ketorolac. ED pain scores at discharge did not change for hospital-admitted and non-admitted patients. The possible reduction in costs was $193,440 during the 12-month observation period, and the average cost per visit decreased by $792. The researchers concluded that the ED order set decreased the rate of hospital admissions and the timeliness of analgesia administration without having a negative impact on the pain of the patients.
AHRQ-funded; HS028584.
Citation: Wachnik AA, Welch-Coltrane JL, Adams MCB .
A standardized emergency department order set decreases admission rates and in-patient length of stay for adults patients with sickle cell disease.
Pain Med 2022 Dec;23(12):2050-60. doi: 10.1093/pm/pnac096..
Keywords: Sickle Cell Disease, Emergency Department, Hospitalization
Reeves SL, Patel PN, Madden B
Telehealth use before and during the COVID-19 pandemic among children with sickle cell anemia.
This study’s goal was to determine telehealth use before and during the COVID pandemic for children ages 1-17 years old with sickle cell anemia (SCA). The authors identified children with SCA continuously enrolled in Michigan Medicaid from January 2019 to December 2020. The study population consisted of 493 children with SCA with a mean age of 8.7 years at study entry. Pre-pandemic there were 4,367 outpatient visits, with all but 19 in-person. Telehealth visits peaked in April 2020 and then began declining. The majority of telehealth visits were with hematologists, followed up adult subspecialists (27%) and pediatrics/family medicine.
AHRQ-funded; HS027632.
Citation: Reeves SL, Patel PN, Madden B .
Telehealth use before and during the COVID-19 pandemic among children with sickle cell anemia.
Telemed J E Health 2022 Aug;28(8):1166-71. doi: 10.1089/tmj.2021.0132..
Keywords: Children/Adolescents, COVID-19, Telehealth, Health Information Technology (HIT), Sickle Cell Disease, Chronic Conditions, Access to Care
Creary SE, Beeman C, Stanek J
Impact of hydroxyurea dose and adherence on hematologic outcomes for children with sickle cell anemia.
The purpose of this study was to quantify the contributions of hydroxyurea dose and medication adherence to the association between hydroxyurea exposure and hematologic parameters in children with sickle cell anemia (SCA.) Using data from children with SCA who were enrolled in two prospective hydroxyurea adherence studies, the researchers assessed the association by video of directly observed therapy or electronic pill bottle and medication administration record. Forty-five participants were included in the analysis. The study reported that higher exposure was related with higher fetal hemoglobin and mean corpuscular volume. The researchers concluded that higher hydroxyurea dose was related with improved hematologic parameters and is affected by level of prescribed dose and adherence.
AHRQ-funded; HS023011.
Citation: Creary SE, Beeman C, Stanek J .
Impact of hydroxyurea dose and adherence on hematologic outcomes for children with sickle cell anemia.
Pediatr Blood Cancer 2022 Jun;69(6):e29607. doi: 10.1002/pbc.29607..
Keywords: Children/Adolescents, Medication, Sickle Cell Disease, Chronic Conditions, Outcomes, Patient Adherence/Compliance
Reeves SL, Dombkowski KJ, Madden B
Considerations when aggregating data to measure performance across levels of the health care system.
Investigators examined attribution when measuring quality at varying levels of the health care system. Using Medicaid claims, they concluded that, when applying attribution models, it was essential to consider the potential to induce health disparities. Further, differential attribution may have unintentional consequences that deepen health disparities, particularly when considering incentive programs for health plans to improve the quality of care.
AHRQ-funded; HS025292; HS025299.
Citation: Reeves SL, Dombkowski KJ, Madden B .
Considerations when aggregating data to measure performance across levels of the health care system.
Acad Pediatr 2022 Apr;22(3s):S119-s24. doi: 10.1016/j.acap.2021.11.013..
Keywords: Sickle Cell Disease, Research Methodologies, Provider Performance
Reeves SL, Freed GL, Madden B
Trends in quality of care among children with sickle cell anemia.
This study’s goal was to assess trends in the use of antibiotic prophylaxis to prevent serious infections and transcranial Doppler (TCD) screening to identify those at highest risk of overt stroke among children with sickle cell anemia (SCA) using validated quality measures. The authors identified children with SCA who were enrolled in Michigan or New York State (NYS) Medicaid programs from 2011 to 2018. Two outcomes were assessed yearly: (a) filling of ≥300 days of antibiotics, and (b) receipt of greater than or equal to one TCD. A total of 1784 children were eligible for antibiotic prophylaxis (Michigan: 384; NYS: 1400). Annual rates of filling ≥300 days of antibiotics ranged from 16% to 22%, showing similar results by state. There was no change in rates of antibiotic filling over time in Michigan, but there was a decrease in NYS. A total of 3439 children with SCA were eligible for TCD screening (Michigan: 710; NYS: 2729). Annual rates of TCD screening ranged from 39% to 45%, which did not change over time.
AHRQ-funded; HS025292.
Citation: Reeves SL, Freed GL, Madden B .
Trends in quality of care among children with sickle cell anemia.
Pediatr Blood Cancer 2022 Feb; 69(2):e29446. doi: 10.1002/pbc.29446..
Keywords: Children/Adolescents, Sickle Cell Disease, Chronic Conditions, Quality of Care