Quality Improvement

Overview

During the SCDTDP 2017-18 grant year, we worked with the UCSF IMPLEMENT Quality Improvement Project, a project funded by the Agency for Health Research and Quality.

Nine sites within the PSCRC participated, tested sickle cell disease measures from the Pediatric Quality Measure Program.

The primary pediatric measure was Transcranial Doppler screening for stroke risk. This measure was defined as the number of children 2 through 15 years of age with sickle cell anemia (HbSS and HbSβ0 thalassemia) who were continuously enrolled in Medicaid and who received TCD ultrasonography during the measurement year.

The primary measure for both adults and pediatrics was Hydroxyurea Counseling, or Anticipatory Guidance Regarding Hydroxyurea Treatment.

The measure was defined as the number of patients aged 9 months and older identified as having SCA (HbSS and HbSβ0 thalassemia), during the measurement year, who received counseling regarding the risks and benefits of treatment with hydroxyurea as part of outpatient care, as measured by documentation in the medical record that anticipatory guidance* occurred.

In addition to this data collection, quality improvement activities occurred at local sites to increase both TCD completion rates and hydroxyurea counseling completed during the measurement year. These efforts were often multidisciplinary, with staff engaged in evaluating small tests of change to increase TCD screening and hydroxyurea counseling. Providers selected several projects: EMR based projects to make it easier to record hydroxyurea counseling in the medical record; family education on the necessity of TCD screening; increased reminders about clinic visits to cut down on no-show rates.

Next Steps

During the 2017-18 SCDTDP grant year, it was announced that a similar quality improvement project would be created in order to capitalize on previous project training and similar measurement projects. This quality improvement work will have an expanded focus on other optional measures.

All sites will concentrate on increasing hydroxyurea prescriptions in addition to the optional projects of TCD screening completions, increasing documentation of plans for transition from pediatric to adult care, immunization completions, and increasing Project ECHO attendance.

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