Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis.
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2021-04
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Background: Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Individuals with SCD are at high likelihood of high acute care utilization and chronic pain episodes. The multiple complications seen in SCD contribute to significant morbidity and premature mortality, as well as substantial costs to the healthcare system. Objectives: SCD is a complex chronic disease resulting in the need for primary, specialty and emergency care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. We report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). We report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit. Methods: The SCD toolbox was adapted from the National Heart, Lung, and Blood Institute recommendations. Toolbox training was provided to quality improvement specialists who then disseminated the toolbox to primary care providers (PCPs) affiliated with the only NC managed care coordination system and ED providers. Tools were made available in paper, online, and in app formats to participating managed care network practices (n=1 800). Medicaid claims data were analyzed for total costs and benefits of the toolbox dissemination for a 24-month pre- and 18-month post-intervention period. Results: There was no statistically significant shift in the number of outpatient specialty visits, ED visits or hospitalizations. There was a small decrease in the number of PCP visits in the post-implementation period. The dissemination resulted in a net cost-savings of $361 414 ($14.03 per-enrollee per-month on average). However, the estimated financial benefit associated with the dissemination of the SCD toolbox was not statistically significant. Conclusions: Although we did not find the expected shift to increased PCP visits and decreased ED visits and hospitalizations, there were many lessons learned.
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Tanabe, Paula, Audrey L Blewer, Emily Bonnabeau, Hayden B Bosworth, Denise H Clayton, Nancy Crego, Marian F Earls, Kern Eason, et al. (2021). Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis. Journal of health economics and outcomes research, 8(1). pp. 18–28. 10.36469/jheor.2021.21535 Retrieved from https://hdl.handle.net/10161/29349.
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Scholars@Duke
Paula J Tanabe
Dr. Tanabe is the Laurel B. Chadwick Distinguished Professor in the Schools of Nursing and Medicine at Duke at the Duke University School of Nursing. Dr. Tanabe is a clinical and health services researcher. Her program of research focuses on improving systems of healthcare and patient outcomes for persons with sickle cell disease, a primarily minority and under-served population. Dr. Tanabe has received funding from the Agency for Health Care Research and Quality, the National Institute of Heart, Lung, and Blood, National Institute of Minority Health and Health Disparities and the National Institute of Nursing Research. Her work is advancing the care of individuals with sickle cell disease with a strong focus on improving pain management in the emergency department during a vaso-occlusive crisis. Her methodological expertise includes conducting multi-site clinical RCT’s, survey methods, qualitative research, quality improvement and implementation science. Dr. Tanabe has a strong passion for her work, individuals with sickle cell disease, and for mentoring students and faculty to conduct important, meaningful work to improve the health and well being of individuals and families.
Audrey L Blewer
Dr. Blewer is an epidemiologist and resuscitation scientist who has focused her areas of inquiry within the domains of resuscitation science, epidemiology, implementation science, and health disparities. She is an Assistant Professor in the Department of Family Medicine and Community Health, Department of Population Health Sciences, and School of Nursing. She also has a joint appointment at Duke-NUS Medical School in the Department of Health Services and Systems Research.
Dr. Blewer has published in several noteworthy journals such as Circulation, Lancet Public Health, Circulation Cardiovascular Quality and Outcomes, and Critical Care Medicine. She is recognized in the field of resuscitation science nationally and internationally. Dr. Blewer is contributing to the upcoming American Heart Association Guidelines writing group for Resuscitation Education and serves on the Editorial Board for the journal Resuscitation Plus. Dr. Blewer works on interdisciplinary research projects at both Duke and Duke-NUS Medical Center
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Nancy Crego
Dr. Nancy Crego is a registered nurse with extensive clinical experience across psychiatric, trauma, adult and pediatric critical care, including pediatric cardiac intensive care and transport. She holds a BSN and MSN in Nursing Administration from Barry University and a PhD in Nursing from the University of Virginia. Prior to joining Duke University School of Nursing, she taught and coordinated undergraduate nursing courses at Georgetown University, focusing on leadership, quality improvement, and pediatric care.
Her research centers on health disparities and the impact of healthcare system factors on the quality and safety of care for acutely and chronically ill populations. Dr. Crego specializes in secondary data analysis, including clinical, cost, and utilization datasets, and has published on methods for applying these data to nursing research. Her current work focuses on pain and systemic inequities in individuals with Sickle Cell Disease.
Nirmish Ramesh Shah
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