Opportunities to optimize the receipt of preventive services among children with sickle cell anemia: A Mixed Methods Approach

点击翻译按钮获取中文摘要

PROJECT SUMMARY The proposed project will provide critical information to inform the development and implementation of interventions to improve the receipt of preventive services among children with sickle cell anemia. National guidelines strongly recommend that children with sickle cell anemia receive routine screenings and be offered preventive medications to reduce the risk of serious complications including infections, strokes, and pain crises. Although these complications are associated with increased health services utilization and cost, and reduced quality of life, only 40% of children receive routine screenings and less than 20% receive preventive medications. Significantly, the mechanisms driving quality gaps in the receipt of preventive services are unknown, limiting our ability to develop and implement impactful interventions. The overall objective of this study is to shed light on these mechanisms and identify opportunities to optimize receipt of preventive services among children with sickle cell anemia, thus reducing disease burden and improving quality of life. The proposed study directly impacts the following AHRQ priority populations: children, racial and ethnic minorities, low-income patients, and those with special healthcare needs. As such, it aligns with AHRQ’s mission to improve efficiency and quality of health care delivery for vulnerable populations. Using a mixed methods approach, we will (1) identify critical targets within the healthcare delivery system, as well as key subgroups of the population, through which intervention can improve the receipt of preventive services for children with sickle cell anemia; (2) identify barriers to and facilitators of receipt of preventive services, and (3) integrate the quantitative findings of patterns of care and adherence deficiencies with the qualitative findings of barriers and facilitators to preventive services to identify intervention targets and strategies that are most likely to improve receipt of preventive services. The mixed methods approach includes analyzing data from three large complementary, nationally representative datasets, combined with primary qualitative data collection. The datasets provide a novel opportunity to provide a population-based perspective on the care of children with sickle cell anemia, as well as national data on prescribing practices. Quantitative methods, including machine learning and time-dependent survival analysis, will enable us to characterize patterns of care associated with receipt of preventive services, as well variation in adherence across providers, patients, caregivers, and insurance type. Qualitative, key informant interviews with provider teams, caregivers, and patients will identify potential barriers to and facilitators of adherence to each preventive service, as well as opportunities for intervention. Finally, the visual integration of the quantitative analysis with the qualitative findings through a joint display will provide essential information regarding which intervention targets and strategies are most likely to improve receipt of preventive services and ultimately reduce morbidity among children with sickle cell anemia.