Related Experiment Video
Updated: Oct 11, 2025
A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy
Trends in quality of care among children with sickle cell anemia
Sarah L Reeves1,2, Gary L Freed1, Brian Madden1
1Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
Insights
Most children with sickle cell anemia (SCA) do not receive recommended antibiotic prophylaxis or transcranial Doppler (TCD) screening. Urgent interventions are needed to improve these critical preventive services for children with SCA.
Area of Science:
- Pediatrics
- Hematology
- Public Health
Background:
- Sickle cell anemia (SCA) management guidelines recommend antibiotic prophylaxis and transcranial Doppler (TCD) screening for children.
- These interventions aim to prevent serious infections and identify stroke risk in pediatric SCA patients.
Purpose of the Study:
- To assess temporal trends in antibiotic prophylaxis prescription fills and TCD screening among children with SCA.
- To evaluate the uptake of these recommended preventive services over time.
Main Methods:
- Utilized claims data from Michigan and New York State Medicaid programs (2011-2018).
- Identified children with SCA eligible for antibiotic prophylaxis (≥300 days fill) and TCD screening (≥1 TCD).
- Analyzed yearly proportions and temporal trends using generalized linear models.
Main Results:
- Antibiotic prophylaxis fill rates ranged from 16-22% and showed no significant change in Michigan, but decreased in NYS.
- TCD screening rates ranged from 39-45% and remained stable over time in both states.
- A significant proportion of eligible children did not receive recommended preventive services.
Conclusions:
- Most children with SCA are not receiving recommended antibiotic prophylaxis and TCD screening.
- There is an urgent need for coordinated interventions to improve the delivery of these essential preventive services.
Introduction:
For decades, it has been recommended that children with sickle cell anemia (SCA) receive antibiotic prophylaxis to prevent serious infections and undergo transcranial Doppler (TCD) screening to identify those at highest risk of overt stroke. We assessed recent temporal trends in antibiotic prophylaxis prescription fills and TCD screening among children with SCA using validated quality measures.
Procedure:
Using validated claims-based definitions, we identified children with SCA who were enrolled in Michigan or New York State (NYS) Medicaid programs (2011-2018). Among recommended age groups, two outcomes were assessed yearly: (a) filling of ≥300 days of antibiotics, and (b) receipt of greater than or equal to one TCD. The proportion of children with each outcome was calculated by state. Temporal trends in each preventive service were assessed using generalized linear models.
Results:
A total of 1784 children were eligible for antibiotic prophylaxis (Michigan: 384; NYS: 1400), contributing 3322 person-years. Annual rates of filling ≥300 days of antibiotics ranged from 16% to 22% and were similar by state. There was no change in rates of antibiotic filling over time in Michigan (p-value: .10), but there was a decrease in NYS (p-value: .02). A total of 3439 children with SCA were eligible for TCD screening (Michigan: 710; NYS: 2729), contributing 10,012 person-years. Annual rates of TCD screening ranged from 39% to 45%, were similar by state, and did not change over time (p-values >.05).
Conclusions:
Most children with SCA do not receive recommended antibiotic prophylaxis and/or TCD screening. New, sustainable, and coordinated interventions across preventive services are urgently needed.
More Related Videos
05:23Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
08:23Characterization of Sickling During Controlled Automated Deoxygenation with Oxygen Gradient Ektacytometry
Published on: November 5, 2019
Related Concept Videos
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
01:28Chronic Kidney Disease III: Interprofessional Care
01:19Standards of Care II
01:22Standards of Care I
01:20Acute Kidney Injury V: Interprofessional Care
01:30Current Trends in Nursing II