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

Area of Science:

• Pediatric Hematology
• Quality Improvement Science
• Clinical Trial Management

Background:

• Sickle cell disease (SCD) is a significant cause of childhood morbidity and mortality.
• Established quality measures for SCD care include hydroxyurea (HU) counseling and transcranial Doppler (TCD) screening.
• Previous implementation of these quality measures in clinical settings for quality improvement (QI) was limited.

Purpose of the Study:

• To assess the impact of a regional quality improvement (QI) collaborative on HU counseling and TCD screening in pediatric SCD patients.
• To evaluate the feasibility and effectiveness of implementing new SCD-specific quality measures.
• To reduce variation and improve adherence to evidence-based care guidelines.

Main Methods:

• A year-long QI collaborative involving 9 Pacific Sickle Cell Regional Collaborative subspecialty clinics.
• Utilized monthly conference calls and run charts with plan-do-study-act (PDSA) cycles for progress tracking.
• Focused on improving HU counseling and TCD screening rates based on newly developed quality measures.

Main Results:

• Significant aggregate improvement in HU counseling rates, from 85% to 98% (P < 0.01).
• Referral frequency for TCD screening increased from 85% to 90% (P = 0.76), but completion rates did not show overall change.
• Reduced variation in care frequencies for both HU counseling and TCD screening over the study period.

Conclusions:

• A regional QI collaborative effectively enhanced HU counseling adherence in pediatric SCD patients.
• While TCD screening referrals saw a modest increase, overall completion rates require further improvement strategies.
• Findings support the adoption of these quality measures by clinicians to improve pediatric SCD outcomes.