Missed Opportunities for Transcranial Doppler Screening Among Children With Sickle Cell Disease. (October 2016)

• Record Type: Journal Article
• Authors: Reeves, Sarah L.; Fullerton, Heather J.; Cohn, Lisa M.; Dombkowski, Kevin J.; Boulton, Matthew L.; Braun, Thomas M.; Lisabeth, Lynda D.
• Is Part Of: Clinical pediatrics. Volume 55:Number 12(2016)
• Page Start: 1093
• Page End: 1099
• Publication Date: 2016-10
• Subjects: sickle cell disease -- pediatric stroke -- stroke prevention -- transcranial Doppler screening -- health services research -- children -- Medicaid -- newborn screening; Pediatrics -- Periodicals; 618.920005
• DOI: 10.1177/0009922815614351
• Languages: English
• ISSNs: 0009-9228

Abstract

Transcranial Doppler (TCD) screening rates remain low among children with sickle cell disease (SCD). We assessed TCD screening rates and missed opportunities for TCD screening. Children 2 to 16 years old with SCD enrolled in Michigan Medicaid for ≥1 year (2007-2011) were identified through newborn screening. Receipt of TCD screening and presence of a missed opportunity (≥1 SCD-related outpatient visit, no TCD screening) were identified through administrative claims. Potential correlates of missed opportunities included SCD-related health services, comorbidities, and demographics. Logistic regression with generalized estimating equations modeled associations between a missed opportunity and correlates. Overall, 353 children contributed 1066 person-years. TCD screening was low yearly (10%-32%); missed opportunities occurred in 73% of the person-years. Increasing age (odds ratio [OR] = 1.11; confidence interval CI = 1.07, 1.15), previous TCD screening (OR = 0.26; CI = 0.16, 0.41), and 4 to 5 (OR = 0.48; CI = 0.26, 0.87) or ≥6 outpatient visits (OR = 0.26; CI = 0.14, 0.49) were associated with a missed opportunity. Reduction of missed opportunities is a potential strategy to increase TCD screening rates.