Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis.


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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Publication Info

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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Audrey L Blewer

Assistant Professor in Family Medicine and Community Health

Audrey L. Blewer, PhD, MPH is an epidemiologist and resuscitation scientist in the Department of Family Medicine and Community Health and Department of Population Health Sciences within Duke University School of Medicine. Dr. Blewer completed her Doctor of Philosophy in Epidemiology at the University of Pennsylvania from the Department of Biostatistics, Epidemiology, and Informatics and her Master of Public Health in Social in Behavioral Sciences from the University of Florida.

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


Nancy Crego

Assistant Professor in the School of Nursing

Dr. Crego is a registered nurse whose clinical experiences include psychiatric, adult trauma, adult critical care, pediatric intensive care, pediatric critical care transport, and pediatric cardiac intensive care nursing. Dr. Crego earned her BSN and her MSN in Nursing Administration at Barry University (Miami, FL), and she earned her PhD in Nursing at the University of Virginia. She came to the Duke University School of Nursing from the School of Nursing and Health Studies at Georgetown University, where she coordinated undergraduate courses and lectured on topics such as leadership, quality and transition to professional practice as well as care of infants and children. 

Her program of research concerns health disparities and understanding factors within the health care system that effect the quality and safety of care in acute and chronically ill people. She has expertise in the use of secondary data and has worked with and analyzed a number of these, including utilization, cost, clinical, registry and repository data. She has also disseminated knowledge about strategies in understanding and using secondary data methods to study clinical and administrative questions in nursing. Most recently her research focus is on Sickle Cell Disease (SCD) pain and understanding health system factors that perpetuate health inequities in people with Sickle Cell Disease.

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