2019 Research Forum

Rigorous and Practical Quality Indicators in Sickle Cell Disease Care at Kern Medical

Simmer Kaur MD R2 1 ; Christina DiCorato MD Graduate RA 1 ; Christina Sugirtharaj MPH MS IV 1 ; David Aguirre MD 1 , Everardo Cobos MD 1,2

1 Kern Medical, Department of Medicine 2 David Geffen School of Medicine UCLA

Objectives

Methods

Conclusions

Introduction

Although sickle cell disease (SCD) was described in the medical literature over 100 years ago, many individuals affected with this condition still do not receive high-quality care. Guidelines for the care of children and adults with SCD are given in the National Heart Lung and Blood Institute’s (NHLBI) 2014 expert panel report on evidence-based management of sickle cell disease. Nevertheless, inequities and gaps in the provision of high-quality care for individuals affected with this condition continue to be documented in the literature. Variation exists in the delivery of recommended care such as immunizations, transcranial Doppler screening, use of Hydroxyurea, delays in timely treatment of painful episodes, and screening and treatment of many other SCD manifestations. As a result, most patients with SCD have no “medical home” and much of the care is provided in the emergency department (ED) EDs are complex systems, designed with limited resources to meet the needs of all patients experiencing medical emergencies. Several aspects of emergency care systems pose challenges to providing optimal care to individuals with SCD. In addition, acute hospitalization of patients with SCD with a variety of medical problems and largely admissions for acute pain crisis are also not ideal setting to provide comprehensive evaluation and long term management. Many patients are managed in the outpatient clinics by a variety of providers in settings lacking resources, education and expertise to deal with such a complicated disease. It is imperative that health systems implement protocols and mitigate scarcity of resources to improve the health, quality of life, and reduce mortality of patients with SCD. The life expectancy of these patients is currently 15-20 years shorter than the general population.

Sickle cell disease requires a comprehensive approach in management. From our study we were able to identify gaps in the care of SCD patients at KM. We hope to bridge these gaps by improving outpatient care, which can be achieved by creating a designated clinic for SCD patients. As acute pain crisis is the most common reason for admission at KM, we hope to improve ER triage and treatment time in acute sickle cell crisis to help decrease the length of stay. • Analysis.” Journal of Clinical Epidemiology , vol. 45, no. 8, 1992, pp. 893–909., doi:10.1016/0895-4356(92)90073-v. • Bean, Christopher J., et al. “Discordance between Self- Report and Genetic Confirmation of Sickle Cell Disease Status in African-American Adults.” Public Health Genomics , vol. 17, no. 3, 2014, pp. 169–172., doi:10.1159/000360260. • “Sickle Cell Disease (SCD).” Centers for Disease Control and Prevention , Centers for Disease Control and Prevention, 17 Nov. 2016, www.cdc.gov/ncbddd/sicklecell/facts.html. • Stewartwest, M. “Laboratory profile of sickle cell disease: A cross-Sectional • Wailoo, Keith,Sickle Cell Disease — A History of Progress and Peril,New England Journal of Medicine,vol.376,no. 9,pages 805-807,2017,doi:10.1056/NEJMp1700101,PMID: 28249142. • Platt, Orah S.,Hydroxyurea for the Treatment of Sickle Cell Anemia, New England Journal of Medicine, volume 358,number 13,pages 1362-1369,year 2008,doi 10.1056/NEJMct0708272,PMID: 18367739. • https://www.nhlbi.nih.gov/sites/default/files/media/doc s/sickle-cell-disease-report%20020816_0.pdf

Retrospective chart review. Data was collected on patient demographics, hospital admissions for various sickle cell complications, re-admission rate, pain management, blood transfusion, iron studies, Hb electrophoresis, hydroxyurea use, preventative care, etc.

The objective of this quality project was to assess quality indicators of SCD, identify challenges and opportunities for improvement in the care of SCD patients at Kern Medical. We conducted a comprehensive evaluation of 61 patients identified in our database with SCD over the past 6 years at KM

Results

References

Complications of Sickle Cell

70

60

50

40

30

20

Number of Patients

10

0

Pain crisis

acute chest syndrome

Pulmonary HTN Stroke

DVT

Vision loss

PE

Ulcers

Avascular necrosis

YES NO BLANK

# Sickle Cell Admission

Number of patients

% of Grand total

Demographic

Quantity

% of Total

0 1 2 3 4 6 7 9

29

47.54% 13.11% 14.75%

8 9 3 1 1 1 2 1 1 1 1 1 1 1

49

80.33%

Insured

12

19.67%

Uninsured

4.92% 1.64% 1.64% 1.64% 3.28% 1.64% 1.64% 1.64% 1.64% 1.64% 1.64% 1.64% 0.00%

56

91.80%

African American

5

8.20%

Caucasian

Acknowledgements

2

3.28%

College

10 12 13 14 17 22 32

9

14.75%

High School

50

81.97%

My sincere gratitude to Dr. Cobos and Dr. Aguirre for their expertise, Christina DiCorato and Christina Sugirtharaj for their help in data collection, and Kern Medical for this opportunity.

Not Documented

5

8.20%

Employed

37

60.66%

Not Documented

1

1.64%

Retired

(blank)

18

29.51%

Grand Total

61

100.00%

Unemployed

109