Determining Adherence to Quality Indicators in Sickle Cell Anemia Using Multiple Data Sources.
Determining Adherence to Quality Indicators in Sickle Cell Anemia Using Multiple Data Sources.
复制标题
使用多个数据源确定镰状细胞性贫血质量指标的遵守情况。
DOI：
10.1016/j.amepre.2016.02.011
复制
发表时间：
2016
影响因子：
5.5
通讯作者：
Snyder,Angela
中科院分区：
文献类型：
--
作者：
Neunert,CindyE;Gibson,RobertW;Lane,PeterA;Verma-Bhatnagar,Pragya;Barry,Vaughn;Zhou,Mei;Snyder,Angela
初级预防的进展改善了镰状细胞性贫血（SCA，即血红蛋白SS-和s β0-地中海贫血）患者的预后。标准的预防措施包括在2岁时首次接种肺炎球菌多糖疫苗（PPV）和经颅多普勒超声（TCD）。虽然有效，但有证据表明，这些干预措施的实施并不理想。本研究报告了这些措施的遵守情况，并使用血红蛋白病注册和监测项目数据检查了各种数据源的一致性。方法回顾性分析2004年1月1日至2008年12月31日期间24-36月龄SCA患儿的资料及SCA中心图。PPV和TCD管理通过医疗补助和儿童健康保险计划行政索赔数据、医疗记录审查和乔治亚州免疫交易和服务登记处确定。分析于2015年进行。结果125例患儿符合纳入标准。45名（36.0%）儿童有两种干预措施的记录，而19名（15.2%）没有任何干预措施的记录。61名（48.8%）儿童只接受了一次干预。其中，PPV多于TCD（分别为77.0%和23.0%,p<0.001）。索赔数据与病历审查之间的一致性在PPV中为中等（κ=0.55），在TCD中为显著（κ=0.74）。结论没有一个单一的、可靠的数据来源来跟踪全州SCA儿童的护理标准。根据研究数据，在监测期间没有普遍实施预防措施。需要进一步的研究来充分跟踪随时间的变化，确定风险群体，并制定评估重要指标的方法。
IntroductionAdvances in primary prophylaxis have resulted in improved outcomes for patients with sickle cell anemia (SCA; i.e., hemoglobin SS- and Sβ0-thalassemia). Standard prophylactic measures include a first pneumococcal polysaccharide vaccine (PPV) and transcranial Doppler ultrasound (TCD) at age 2 years. Though efficacious, evidence suggests that delivery of these interventions is suboptimal. This study reports adherence to these measures and examines concordance across various data sources, using Registry and Surveillance for Hemoglobinopathies project data.MethodsRetrospective database and SCA center chart review identified children with SCA aged 24–36 months between January 1, 2004, and December 31, 2008. PPV and TCD administration were determined through Medicaid and Children’s Health Insurance Program administrative claims data, medical record review, and Georgia Registry of Immunization Transaction and Services. Analysis was conducted in 2015.ResultsA total of 125 children met inclusion criteria. Forty-five (36.0%) children had documentation of both interventions, whereas 19 (15.2%) had no documentation of either intervention. Sixty-one (48.8%) children obtained only one intervention. Of these, more were likely to have had PPV than TCD (77.0% vs 23.0%, respectively,p<0.001). Agreement between claims data and medical record review was moderate for PPV (κ=0.55) and substantial for TCD (κ=0.74).ConclusionsNo single, reliable data source for tracking standard of care for children with SCA statewide was found. According to study data, prophylaxis measures were not universally implemented during the surveillance period. Further research is needed to adequately track changes over time, determine risk groups, and develop methods of evaluating important metrics.