Reeves Sarah L, Madden Brian, Freed Gary L, Dombkowski Kevin J
Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor.
JAMA Pediatr. 2016 Jun 1;170(6):550-6. doi: 10.1001/jamapediatrics.2015.4859.
With transcranial Doppler (TCD) screening, we can identify children and adolescents with sickle cell anemia who are at the highest risk of stroke. An accurate claims-based method for identifying children and adolescents with sickle cell anemia was recently developed and validated that establishes the necessary groundwork to enable large population-based assessments of health services utilization among children and adolescents with sickle cell anemia using administrative claims data.
To assess the feasibility of using administrative claims data to identify and describe the receipt of TCD screening among children and adolescents with sickle cell anemia and to characterize opportunities for intervention.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study using Medicaid claims data from 2005 to 2010. Medicaid claims data were obtained from the following states: Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. Children and adolescents 2 to 16 years of age with sickle cell anemia were identified by the presence of 3 or more Medicaid claims with a diagnosis of sickle cell anemia within a calendar year (2005-2010). A total of 4775 children and adolescents contributed 10 787 person-years throughout the study period. Data were analyzed in 2015. A subset of children and adolescents enrolled for 2 or more consecutive years was identified to examine potential predictors of TCD screening, which included age, sex, previous receipt of TCD screening, state of residence, and health services utilization (well-child visits, outpatient visits, emergency department visits, and inpatient visits).
Receipt of TCD screening was assessed by year and state. Using logistic regression with generalized estimating equations, we included associated predictors in a multivariable model to estimate odds of TCD screening.
For a total of 4775 children and adolescents 2 to 16 years of age, TCD screening rates increased over the 6-year study period from 22% to 44% (P < .001); rates varied substantially across states. A subset of 2388 children and adolescents with sickle cell anemia (50%) was enrolled for 2 or more consecutive years. Each year of increasing age was associated with 3% lower odds of TCD screening (odds ratio, 0.97 [95% CI, 0.95-0.98]; P = .002). Previous receipt of TCD screening (odds ratio, 2.44 [95% CI, 2.11-2.81]; P < .001) and well-child visits (odds ratio, 1.10 [95% CI, 1.03-1.18]; P = .007) were associated with higher odds of receiving a TCD screening.
Despite national recommendations, TCD screening rates remain low. Successful strategies to improve TCD screening rates may capitalize on the numerous health care interactions among children and adolescents with sickle cell anemia.
通过经颅多普勒（TCD）筛查，我们能够识别出镰状细胞贫血症患儿和青少年中中风风险最高的人群。最近开发并验证了一种基于索赔的准确方法，用于识别镰状细胞贫血症患儿和青少年，这为利用行政索赔数据对镰状细胞贫血症患儿和青少年的医疗服务利用情况进行大规模人群评估奠定了必要基础。
评估使用行政索赔数据识别和描述镰状细胞贫血症患儿和青少年接受TCD筛查情况以及确定干预机会的可行性。
设计、地点和参与者：采用回顾性横断面研究，使用2005年至2010年的医疗补助索赔数据。医疗补助索赔数据来自以下州：佛罗里达州、伊利诺伊州、路易斯安那州、密歇根州、南卡罗来纳州和得克萨斯州。通过在一个日历年（2005 - 2010年）内有3次或更多次诊断为镰状细胞贫血症的医疗补助索赔来识别2至16岁的镰状细胞贫血症患儿和青少年。在整个研究期间，共有4775名儿童和青少年贡献了10787人年的数据。数据于2015年进行分析。确定了连续2年或更长时间入组的儿童和青少年子集，以检查TCD筛查的潜在预测因素，包括年龄、性别、既往TCD筛查情况、居住州以及医疗服务利用情况（儿童健康检查、门诊就诊、急诊科就诊和住院就诊）。
按年份和州评估TCD筛查的接受情况。使用带有广义估计方程的逻辑回归，我们在多变量模型中纳入相关预测因素以估计TCD筛查的几率。
对于总共4775名2至16岁的儿童和青少年，TCD筛查率在6年研究期间从22%增至44%（P <.001）；各州之间筛查率差异很大。2388名镰状细胞贫血症儿童和青少年（50%）连续2年或更长时间入组。年龄每增加一岁，TCD筛查几率降低3%（优势比，0.97 [95%置信区间，0.95 - （此处原文有误，应为0.98）0.98]；P =.002）。既往接受TCD筛查（优势比，2.44 [95%置信区间，2.11 - 2.81]；P <.001）和儿童健康检查（优势比，1.10 [95%置信区间，1.03 - 1.18]；P =.007）与接受TCD筛查的较高几率相关。
尽管有国家推荐，但TCD筛查率仍然较低。提高TCD筛查率的成功策略可能利用镰状细胞贫血症儿童和青少年之间众多的医疗保健互动。
