scholarly journals Using Lean Six Sigma to Develop a Patient Centered Medical Home for Adults with Sickle Cell Disease

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3408-3408
Author(s):  
Shirley Johnson ◽  
Sarah Hartigan ◽  
Emily Holt ◽  
Daniel Sop ◽  
Chantal McHenry ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Length Of Stay ◽  
Sickle Cell ◽  
Six Sigma ◽  
Medical Home ◽  
Lean Six Sigma ◽  
Patient Centered Medical Home ◽  
Target Area ◽  
Cell Disease ◽  
Patient Centered

Background: Adults with sickle cell disease (SCD) suffer poor quality, disparities, higher utilization and mortality, and unmet medical need. Thus, in 2017 Virginia Commonwealth University Health (VCU) used pilot results and axioms of the Patient-Centered Medical Home (PCMH) and Lean Six Sigma quality improvement to build an Adult SCD Medical Home. Methods and Results: VCU funded the program in October 2017. We implemented it over the next fifteen months. We first used a Six Sigma QI cycle called DMAIC (Define, Measure, Analyze, Improve and Control). Define: we defined three improvement targets in year one: inpatient, emergency department (ED), and ambulatory care. Behavioral health, program evaluation, ambulatory clinical policies, and pediatric to adult transition were added in year two. We identified ourselves or recruited hospital partners as champions/leaders for each care target area. Each formed a multidisciplinary implementation team. The inpatient care team actually preceded Medical Home funding. Where feasible, each team conducted PDSA cycles to test and improve best practices or metrics. Measure: we ranked 567 adult SCD patients based on their CY 2017 30-day readmissions, length of stay, 3-day ED returns, ED discharges, inpatient days and discharges, outpatient visits, ED use, and charges. Each team also developed metrics. Analyze: The top 50 highest utilizers by charges were targeted for intervention. Improve: We aimed for six 12-month intervention patient results: 1) reduce readmissions by 15%; 2) reduce average length of stay by 1.5 days; 3) reduce charges by 15%; 4) improve compliance with SCD inpatient guidelines; 5) improve quality, safety, and financial reporting; 6) improve patient experience. Leaders also used Six Sigma tools weekly to oversee teams, identify resources, plan, and hire staff: for example, we ranked the urgency of steps using "Now, Later, Latest" process charts, and documented progress using "Quick Wins" communication logs. Control: Processes were continuously amended. Stakeholders met and supported us monthly to quarterly. We distributed an annual report. Metric results are presented in a separate abstract. Conclusion: Lean Six Sigma QI principles were effective for developing and implementing an adult SCD medical home. We believe the above processes could be replicated elsewhere. Figure Disclosures Lipato: Novartis: Honoraria. Smith:Novartis: Consultancy, Honoraria.

scholarly journals Sickle cell disease pain management and the medical home

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 433-438 ◽  
Author(s):  
Jean L. Raphael ◽  
Suzette O. Oyeku
Keyword(s):  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Medical Home ◽  
Cost Effective ◽  
Cell Disease ◽  
Patient Centered ◽  
Centered Care ◽  
The Individual ◽  
Effective Models

Pain is the most common cause for hospitalization and acute morbidity in sickle cell disease (SCD). The consequences of SCD-related pain are substantial, affecting both the individual and the health care system. The emergence of the patient-centered medical home (PCMH) provides new opportunities to align efforts to improve SCD management with innovative and potentially cost-effective models of patient-centered care. The Department of Health and Human Services has designated SCD as a priority area with emphasis on creating PCMHs for affected patients. The question for patients, clinicians, scientists, and policy-makers is how the PCMH can be designed to address pain, the hallmark feature of SCD. This article provides a framework of pain management within the PCMH model. We present an overview of pain and pain management in SCD, gaps in pain management, and current care models used by patients and discuss core PCMH concepts and multidisciplinary team–based PCMH care strategies for SCD pain management.

scholarly journals Improved Utilization Amongst Adult Sickle Cell Disease Patients: A Multi-Disciplinary Medical Home Approach

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 22-23
Author(s):  
Daniel Sop ◽  
Shirley Johnson ◽  
Benjamin Jaworowski ◽  
Wally R Smith
Keyword(s):  
Sickle Cell Disease ◽  
Length Of Stay ◽  
Sickle Cell ◽  
Medical Home ◽  
Research Funding ◽  
Readmission Rate ◽  
Cost Savings ◽  
Multidisciplinary Teams ◽  
Cell Disease ◽  
Number Of Patients

Background Worldwide, Sickle Cell Disease (SCD) is the most common monogenetic disorder. SCD is costly to the American health care system: $460,151 per patient for the 100,000 affected US patients. Biological and behavioral health comorbidities with limited hospital resources contributed to a cost increase in SCD readmissions at the Virginia Commonwealth University Health System (VCUHS) from 2012-2016, after a long history of decline. With increasing census, in FY16 the 30-day SCD readmission rate was 33.7%, up from 22.5% in FY14. The average SCD length of stay was 6.7 days, compared with an expected length of 4.2 days. The number of ED visits for SCD patients in FY17 was projected to be double that of FY14. The percent of ED returns in 3 days was projected to be triple that of FY14. Method The VCU Adult SCD Medical Home (ASCMH) was funded and launched to address this issue, based on the success of a pilot that showed cost savings of $333,000 for 5 patients in 12 months. The SCD ASCMH officially began January 1,2018 with a two-year pilot funding period. The ASCMH was structured and designed using quality improvement (QI) principles and consisted of multidisciplinary teams to coordinate inpatient care, emergency care, and ambulatory care respectively. Evaluation compared utilization during CY 2017 (pre-intervention) versus CY 2019 (2 years post intervention). For all patients we compared the average 30-day readmission rate, the average length of stay (ALOS), the average 3-Day ED return rate, the number of ED discharges, the numbers of inpatient days, inpatient discharges, and outpatient visits, the number of patients who used the ED, and total VCU charges. Results Among 541 (2017) and 592 (2019) SCD adults, including 40.6% males and 59.4% females, comparing pre-intervention to intervention, average utilization and VCU charges were either numerically or statistically significantly reduced. Mean 30-day readmission rates were reduced (31.60% vs 20.40%) ALOS was reduced (5.6 days vs 4.3 days), inpatient days were reduced (5313 days vs 3340 days), and total charges were significantly reduced ($15,664,895 vs $13,939,842). Conclusion At VCU, a multi-disciplinary ASCMH that featured intensive case management (CM) reduced annual utilization and cost savings for adult SCD patients. CM program elements that were most effective should be studied in the future and next steps should include a randomized controlled trial that can demonstrate evidence of their efficacy in strengthening and improving utilization Table Disclosures Smith: Emmaeus Pharmaceuticals, Inc.: Consultancy; GlycoMimetics, Inc.: Consultancy; Novartis, Inc.: Consultancy, Other: Investigator, Research Funding; Shire, Inc.: Other: Investigator, Research Funding; Imara: Research Funding; Novo Nordisk: Consultancy; Ironwood: Consultancy; Pfizer: Consultancy; Incyte: Other: Investigator; Health Resources and Services Administration: Other: Investigator, Research Funding; NHLBI: Research Funding; Patient-Centered Outcomes Research Institute: Other: Investigator, Research Funding; Global Blood Therapeutics, Inc.: Consultancy, Research Funding; Shire: Research Funding.

Sickle cell disease pain management and the medical home

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 433-438 ◽  
Author(s):  
Jean L. Raphael ◽  
Suzette O. Oyeku
Keyword(s):  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Medical Home ◽  
Cost Effective ◽  
Cell Disease ◽  
Patient Centered ◽  
Centered Care ◽  
The Individual ◽  
Effective Models

Abstract Pain is the most common cause for hospitalization and acute morbidity in sickle cell disease (SCD). The consequences of SCD-related pain are substantial, affecting both the individual and the health care system. The emergence of the patient-centered medical home (PCMH) provides new opportunities to align efforts to improve SCD management with innovative and potentially cost-effective models of patient-centered care. The Department of Health and Human Services has designated SCD as a priority area with emphasis on creating PCMHs for affected patients. The question for patients, clinicians, scientists, and policy-makers is how the PCMH can be designed to address pain, the hallmark feature of SCD. This article provides a framework of pain management within the PCMH model. We present an overview of pain and pain management in SCD, gaps in pain management, and current care models used by patients and discuss core PCMH concepts and multidisciplinary team–based PCMH care strategies for SCD pain management.

Evaluation of Intravenous Diphenhydramine Use in Patients with Sickle Cell Vaso-Occlusive Crisis

2020 ◽  
pp. 001857872095417
Author(s):  
Katherine Rector ◽  
Shelby Merchant ◽  
Rachel Crawford ◽  
Justin R. Arnall ◽  
James Symanowski ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Length Of Stay ◽  
Sickle Cell ◽  
Cell Disease ◽  
Median Length ◽  
Significant Difference ◽  
Oral Group ◽  
Icd 10 ◽  
Secondary Endpoints ◽  
Group 2

Purpose: To compare the incidence of oversedation between oral and parenteral diphenhydramine therapy for treatment of opioid-induced pruritus in patients with sickle cell disease vaso-occlusive crisis (SCD VOC). Methods: This retrospective, single-center, cohort study included patients greater than or equal to 18 years old with sickle cell disease admitted for vaso-occlusive crisis who received either intravenous or oral diphenhydramine for opioid-induced pruritus. Patients were identified through ICD-9 and ICD-10 codes from June 1, 2016 through July 1, 2017. Rates of oversedation were compared between the 2 formulations. Secondary endpoints included length of stay, amount and duration of diphenhydramine, rate of acute chest and indication for IV therapy. Results: Fifty unique patients were included in the analysis representing 121 admissions. Seven patients received both formulations on separate admissions and were included in both groups. Twenty-nine percent of patients in the IV diphenhydramine group experienced oversedation (12/42) versus 13% in the oral diphenhydramine group (2/15, P = .312). The average number of admissions was significantly higher in the IV versus oral group (2.45 vs 1.20; P = .005) with average and median length of stay also significantly higher in the IV versus oral group (30.57, 16.0 vs 10.67, 10.0; P = .003). Conclusion: While there was no statistically significant difference in the rates of oversedation with use of IV versus oral diphenhydramine formulations, patients with SCD VOC who received IV diphenhydramine had more frequent admissions and a longer length of stay. Clinicians may consider oral diphenhydramine preferentially in appropriate patients over IV administration.

Variation in hospitalizations and hospital length of stay in children with vaso-occlusive crises in sickle cell disease

2005 ◽  
Vol 44 (2) ◽  
pp. 182-186 ◽  
Author(s):  
Julie A. Panepinto ◽  
David C. Brousseau ◽  
Cheryl A. Hillery ◽  
J. Paul Scott
Keyword(s):  
Sickle Cell Disease ◽  
Length Of Stay ◽  
Sickle Cell ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cell Disease

The Incidence of Neonatal Abstinence Syndrome in Babies Born to Women with Sickle Cell Disease: A Single Center Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3225-3225
Author(s):  
Cynthia L Anderson ◽  
Karin J Blakemore ◽  
Sophie Lanzkron
Keyword(s):  
Sickle Cell Disease ◽  
Length Of Stay ◽  
Sickle Cell ◽  
Maternal Age ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Cell Disease ◽  
Live Births ◽  
Hospital Stays ◽  
The Mean

Abstract Abstract 3225 BACKGROUND: Little is known about the neonatal outcomes of infants born to mothers with SCD. Women with SCD are often treated for pain with opioid medication either intermittently or chronically throughout pregnancy. The incidence of withdrawal or neonatal abstinence syndrome has not been well described making counseling of these women about the risks and benefits of opioid therapy during pregnancy difficult. The objective of this study was to determine the incidence of neonatal abstinence syndrome (NAS) in babies born to women with sickle cell disease. METHODS: All pregnancies in women with sickle cell disease were identified within the Johns Hopkins Hospital between January 1, 2001 and January 1, 2011. Retrospective data collection was performed using the electronic medical record. Demographic and outcome information recorded included maternal age, gestational age at time of delivery, outcome of pregnancy, maternal genotype, neonatal intensive care unit (NICU) admissions, neonatal abstinence syndrome diagnosis and neonatal length of stay. Student t-tests and chi square analysis were used to compare outcomes as appropriate. RESULTS: 69 unique patients were identified. From these 69 women, 94 pregnancies were identified. Of these 94 pregnancies, 83 live births were noted. The other 11 pregnancies included 3 spontaneous abortions, 3 ectopic pregnancies, 4 terminations and 1 fetal death in utero. The mean maternal age at time of delivery was 25.5 +/− 5.1 years. The mean gestational age was 36 weeks 2 days (median 36 weeks 6 days with a range of 31 weeks 4 days to 39 weeks 3 days). Of the 83 live births noted in this retrospective cohort, 22 (27%) of these infants were admitted to the NICU and17 (20%) were diagnosed with neonatal abstinence syndrome. Of the 17 infants born with NAS, 12 infants (70%) were born to mothers with SS disease, 3 infants (18%) to mothers with Sβthalassemia and 2 infants (12%) to mothers with SC disease. 53% of babies born with NAS were delivered by C-section which was not statistically significantly different than babies born without NAS (42% p=0.60) The mean birth weight of the babies with NAS was 2521 grams compared to babies without NAS which was 2853 grams (p=0.07). 59% of babies with NAS required NICU care compared to 16% of babies without NAS (p<0.001). The mean length of stay for babies with NAS was significantly longer than those babies without NAS (14.7 days vs. 5.8 days, p=0.003). Of the babies without NAS, 44% had extended hospital stays due to baby-associated complications and the mean LOS was 10.6 days; 10% had extended hospital stays due to complications of the mother with a mean LOS of 6.5 days; and the mean LOS for the 45% of those without mother or baby complications was 2.5 days. CONCLUSIONS: Current recommendations include the use of opioids as needed for vaso-occlusive pain in pregnancies complicated by sickle cell disease. While effective, our study demonstrates that a significant percentage of infants exposed to opioids in utero develop neonatal abstinence syndrome. Future studies are indicated to delineate a dose-response relationship if one exists as well as alternative therapies to address this newly recognized important neonatal co-morbidity. Disclosures: Lanzkron: Hemaquest: Membership on an entity's Board of Directors or advisory committees; NHLBI: Research Funding.

Venous Thromboembolism In Pregnant Women With Sickle Cell Disease

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2217-2217
Author(s):  
Craig D. Seaman ◽  
Margaret V. Ragni ◽  
Charity G. Moore ◽  
Jie Li ◽  
Jonathan Yabes
Keyword(s):  
Venous Thromboembolism ◽  
Sickle Cell Disease ◽  
Length Of Stay ◽  
Pregnant Women ◽  
Sickle Cell ◽  
Pregnancy Complications ◽  
Categorical Variables ◽  
Acute Chest Syndrome ◽  
Cell Disease ◽  
Discharge Data

Abstract Background The risk of venous thromboembolism (VTE) is increased in pregnancy and sickle cell disease (SCD), yet the rates of pregnancy-related VTE are not firmly established in SCD, nor are other SCD-related complications, including pneumonia, vasooclusive crisis (VOC), and acute chest syndrome (ACS), which may be clinically indistinguishable from VTE. Moreover, the American College of Chest Physicians has made no recommendations regarding thromboprophylaxis in pregnant women with SCD. Methods Inpatient hospital discharge data for PE for the most recent 5-year period available, 2007-2011, were obtained from the Pennsylvania Health Care Cost Containment Council (PHC4). We compared VTE, pregnancy complications, medical co-morbidities, and mortality among pregnant women with and without SCD. Among pregnant SCD women with and without VTE, we also compared rates of pneumonia, vasooclusive crisis (VOC), and acute chest syndrome (ACS). All patient identifiers were removed. Diagnostic categories and co-morbidities were obtained using ICD-9 codes. Data from categorical variables were analyzed by chi-square or Fisher's exact test; and from continuous variables by two-sample Student t-test. Results The prevalence of VTE was 2.8% among pregnant women with SCD. Among pregnant women with SCD and VTE, the rate of pneumonia, 28.6% vs. 4.4%, p=0.043, was significantly higher than in those without VTE. While somewhat higher, the rates of VOC, 57.1% vs. 24.7%, p=0.073, and ACS, 14.3% vs. 2.4%, p=0.177, were not significantly different between pregnant SCD VTE and non-VTE groups. Comparing VTE and non-VTE pregnant SCD women, the rate of pregnancy complications did not differ, p=0.999; nor did the rates of medical co-morbidity, other than diabetes, 28.6% vs. 3.6%, p=0.031. Among the subset of pregnant SCD with pneumonia, the prevalence of VOC, 80.0% vs. 36.1%, p=0.001; ACS, 35.0% vs. 2.9%, p<0.001; and length of stay, 12.5 vs. 4.6 days, p=0.030, were significantly greater than in those without pneumonia. Among the subset of SCD pregnancies with VOC, the prevalence of preeclampsia, 28.4% vs. 13.5%, p=0.003; pneumonia, 15.7% vs. 2.6%, p=0.001; ACS, 12.8% vs. 0.6%, p<0.001; and length of stay, 7.7 vs. 3.6 days, p<0.001, were significantly more common than in those without VOC. Among the subset of SCD pregnancies with ACS, the rates of intrauterine fetal death, 14.3% vs. 1.6%, p=0.036; postpartum infection, 28.6% vs. 6.6%, p=0.016; pneumonia, 50.0% vs. 5.3%, p<0.001; and VOC, 92.9% vs. 36.5%, p<0.001, were significantly higher than in those without ACS. Overall, the rate of VTE, among SCD women with pneumonia, VOC, and/or ACS, 6.6%, was significantly higher than among those without these conditions, 2.2%, p<0.001. Discussion The prevalence of pregnancy-related VTE in women with SCD, while low, 2.8%, appears to be at least 10-fold greater than the general 0.2% incidence of pregnancy-related VTE in the unaffected population. Further, the higher rates of VTE we observed among pregnant women with SCD-related complications, including pneumonia, VOC, or ACS, and the well-recognized potential clinical overlap with VTE, suggest that VTE may be missed in such women, and that VTE rates in pregnant women with SCD may be higher than herein reported or previously recognized. The presence of pneumonia, VOC, or ACS appears to be associated with VTE and may be a potential marker(s) of its occurrence. Prospective studies, however, are needed to determine the incidence of VTE in pregnant women with SCD with and without complicating pneumonia, VOC, and/or ACS. We conclude that pregnancy-related VTE may be more common than previously recognized in pregnant women with SCD and, if confirmed, such women might be candidates for thromboprophylaxis. Disclosures: No relevant conflicts of interest to declare.

Vasoocclusive Painful Episodes and the Risk of Acute Chest Syndrome in Children with Sickle Cell Disease: Does the Selection of Parenteral Opioid Matter?

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 442-442
Author(s):  
Ram V. Kalpatthi ◽  
Matt Hall ◽  
Jignesh Dalal ◽  
Gerald M Woods
Keyword(s):  
Sickle Cell Disease ◽  
Length Of Stay ◽  
Respiratory Depression ◽  
Sickle Cell ◽  
Patient Population ◽  
Lower Risk ◽  
Acute Chest Syndrome ◽  
Cell Disease ◽  
Median Length ◽  
Hospitalization Costs

Abstract Background: Vaso-occlusive painful episodes (VOC) is the most common cause of hospitalization in patients with sickle cell disease (SCD) that often requires opioid analgesics and intravenous fluids. However, due to respiratory depression, the use of opioids during these painful episodes has been associated with the risk of development of acute chest syndrome (ACS), the major cause of early mortality in these patients. Nalbuphine is a unique opioid analgesic that effectively treats pain but lacks significant respiratory depression. Previous small scale studies (Pediatr Blood Cancer 2005 and J Pediatr Hematol Oncol 2011) suggested a lower risk of ACS in patients receiving Nalbuphine during VOC when compared with morphine. We sought to compare outcomes and the risk of ACS in pediatric sickle cell patients hospitalized for VOC in relationship to different opioid treatments. Methods: We used the Pediatric Health Information System (PHIS), an administrative database of children's hospitals in the US. Patients ≤ 21 years of age with SCD from 43 hospitals from 2005-2013 were included in the study. SCD patients who had a primary diagnosis VOC (ICD-9 codes 282.62, 282.64, 282.42 and 282.69) were included. VOC hospitalizations were divided into four different narcotic analgesic groups. In bivariate analyses, we compared patient demographics, treatment details, risk of ACS, length of stay, hospital costs, and readmissions across groups using chi-square tests or Kruskal-Wallis tests as appropriate. Multivariable models accounted for hospital clustering with generalized estimating equations for binary outcomes and generalized linear mixed effects models with random hospital intercepts and an exponential distribution (due to skewness of the data) for continuous outcomes. A p-value <.05 was considered statistically significant. Results: From 2005 to 2013, a total of 11260 unique pediatric SCD patients were identified. These patients had 42688 VOC hospitalizations, and received a single parenteral narcotic analgesic during each hospitalization (Morphine 82.2%, Hydromorphone 13.3%, Fentanyl 2.4% and Nalbuphine 2.1% of VOC hospitalizations). Table 1 describes the outcomes of VOC hospitalizations for all four narcotic groups. In unadjusted analysis, patients who received Nalbuphine only had significantly lower risk of ACS diagnosis (5.6%), ICU admissions (0.9%), shorter median length of stay (2 days) and lower median hospitalization costs ($4345) [Table 1]. Patients who received Morphine had less readmission within 3 and 7 days of discharge after VOC hospitalizations (Table 1). Multivariate analysis after adjusting for age, gender, hospital, season, race, payer source, and complex chronic conditions confirmed that patients who received Nalbuphine had significantly lower risk of ACS diagnosis, ICU admissions, shorter median length of stay, and lower median hospitalization costs compared to patients who received Morphine, Hydromorphone or Fentanyl (Table 2). Conclusions: In our largest pediatric in-patient sickle cell cohort, Nalbuphine was associated with significantly lower risk of development of ACS when compared with other opioids. In addition, patients received Nalbuphine had significantly lower ICU admissions, shorter hospital stay and lower hospitalization costs suggesting better pain control. However, our study shows that Nalbuphine in this patient population is rarely utilized. Prospective studies are needed to confirm this association and to elucidate the mechanisms that underlie these beneficial effects of Nalbuphine in this patient population. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals A Patient-Centered Approach to Gathering Information on Social Determinants of Health from Patients with Sickle Cell Disease in Preparation for Their Transition to Adult Care

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4943-4943
Author(s):  
Katherine EC Smith ◽  
Jessica R Cox ◽  
Rosalind L Haynes ◽  
Nicole Ivette Bohnker ◽  
Kay L Saving
Keyword(s):  
Sickle Cell Disease ◽  
Community Health ◽  
Social Determinants Of Health ◽  
Sickle Cell ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Transition To Adult Care ◽  
Cell Disease ◽  
Adult Care ◽  
Patient Centered

Abstract Background: Transition from pediatric to adult care has been a recent focus of sickle cell programs across the country due to patients with sickle cell disease (SCD) to living longer. 1 Transition programs for other chronic conditions focus largely on patient knowledge of the disease, treatments, and appointment compliance but for patients with SCD, social determinants of health (SDOH) must also be considered when guiding patients toward adult care. 2 Historically, lack of acknowledgement of the importance of relationships and trust building when addressing SDOH has led to barriers in patient responsiveness. 3 To facilitate this aspect of transition, our recently hired Community Health Worker (CHW) developed a Community Health Transitional Questionnaire (CHTQ) and conducted a Quality Improvement (QI) project to address SDOH in a patient-centered manner during transition to adult care visits at the clinic. Aims: Refine the CHTQ by gathering the "voice of the customer" to provide a more patient-centered approach to transition to adult care for patients with SCD. Complete the CHTQ with 70% of transition-aged (12-25 years) patients by 7/1/21. Methods: The CHTQ consists of 32 questions about SDOH in 8 categories (Food, Housing, Money/Finances, Transportation, Education/Work, Family and Other Support, Stress Prior to/After COVID, and Sleep). Thirty pediatric sickle cell patients were identified as being within the established transitional age group. A series of Plan-Do-Study-Act (PDSA) cycles were used to refine the CHTQ. Through patient/caregiver feedback, small increments of change were used to establish a CHTQ that would improve patient care and be accepted by the patients/caregivers. PDSA #1: During regularly scheduled appointments, two patients and their caregivers met with the CHW who described the purpose of the CHTQ and then asked the patient to privately complete the CHTQ. PDSA #2: Because of feedback received from PDSA #1, the CHW allowed the next two patients to have caregivers present while answering the CHTQ, but explained that ideally the patient should be able to answer the CHTQ without input from their caregiver before transition to an adult environment. PDSA #3: Because of the feedback received from PDSA #2, the CHW accompanied the clinic RN to the exam room and worked the CHTQ into the nursing check-in questions in an informal manner making the questions seem more routine. Results: After 3 PDSA cycles, 17 additional patients/caregivers completed the CHTQ without issues or concerns. A total of 22/30 (73%) CHTQs met the goal of completion by 7/1/21. One additional CHTQ has been completed since. Using the information from the CHTQ, the team has been able to better address individualized SDOH for each patient. For example, one area of concern identified was transportation with 9/23 (39%) patients expressing concerns getting to & from appointments and/or school/work. Transportation needs were then discussed with the clinic social worker who is now working with those patients, giving them tools to arrange transportation. Conclusion For SCD patients, it appears imperative that a relationship be established prior to inquires about SDOH. Using an informal patient-centered approach with the CHTQ was more likely to gain patient trust and allowed the CHW to obtain information needed to assist the patient with SDOH issues. Once SDOH issues were identified through the CHTQ, the CHW was able to find patient-driven, individualized resources addressing those concerns. References DeBaun, M.R. & Telfair, J. (2012). Transition and Sickle Cell Disease. PEDIATRICS, 130(5), 926-935 https://doi.org/10.1542/peds.2011-3049 Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals. Canadian Medical Association Journal, 188(17-18), E474-E483. https://doi.org/10.1503/cmaj.160177 Cheney, C., Pecci, A., & Porter, S (2020, May). Social Determinants of Health: Lead or Partner. HealthLeaders. https://www.healthleadersmedia.com/clinical-care/social-determinants-health-lead-or-partner-0 Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document