镰状细胞病成年患者的质量指标和医疗保健利用情况。

Quality Metrics and Health Care Utilization for Adult Patients with Sickle Cell Disease.

机构信息

Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.

Johns Hopkins University School of Medicine, Baltimore, MD, USA.

出版信息

J Natl Med Assoc. 2019 Feb;111(1):54-61. doi: 10.1016/j.jnma.2018.05.003. Epub 2018 Jun 22.

DOI:10.1016/j.jnma.2018.05.003

PMID:30129484

Abstract

BACKGROUND

To date, there are no standardized, well-accepted, quality metrics that guide care for adults with sickle cell disease (SCD). The primary objective of this study was to evaluate the quality metrics that are in use at the Adult Sickle Cell Disease Program at Johns Hopkins Hospital (JHH) and the applicability of the metrics to Kaiser Permanente Mid-Atlantic States (KPMAS), an integrated healthcare system with a developing adult sickle cell disease program.

METHODS

We performed a retrospective cross-sectional study of 146 KPMAS and 308 JHH patients from January 1, 2014-December 31, 2015. Demographics, genotype and data on several key quality metrics (yearly screening labs, documented vaccinations and appropriate hydroxyurea prescriptions) were collected from electronic health records (EPIC Systems). We defined hydroxyurea adherence as having had at least 6 months of refills prescribed during the two years of study by either EHR or patient report.

RESULTS

Patients at KPMAS were older than those at JHH (median age 44 and 33 respectively) and less likely to have hemoglobin SS disease (29% and 66% respectively). Among KPMAS patients, 85% had documentation of any pneumococcal vaccination compared to 87% at JHH. 21 of 54 eligible patients at KPMAS and 95 of 165 eligible patients at JHH were prescribed hydroxyurea. At both institutions, 62% of patients were adherent to hydroxyurea. There were limitations to diagnosis coding and availability of vaccination and refill documentation.

CONCLUSIONS

Interventions to improve preventative care adherence are needed to improve outcomes in both academic medical centers and integrated health systems.

摘要

背景

迄今为止，尚无指导成人镰状细胞病（SCD）护理的标准化、公认的质量指标。本研究的主要目的是评估约翰霍普金斯医院（JHH）成人镰状细胞病计划中使用的质量指标，以及这些指标在凯撒永久医疗集团中大西洋中部各州（KPMAS）的适用性，KPMAS 是一个拥有正在发展的成人镰状细胞病计划的综合性医疗系统。

方法

我们对 2014 年 1 月 1 日至 2015 年 12 月 31 日期间的 146 名 KPMAS 和 308 名 JHH 患者进行了回顾性横断面研究。从电子健康记录（EPIC Systems）中收集了人口统计学、基因型以及几项关键质量指标（每年的筛查实验室、记录的疫苗接种情况和适当的羟基脲处方）的数据。我们将羟基脲的依从性定义为在研究的两年中，无论是通过 EHR 还是患者报告，都至少有 6 个月的处方续药。

结果

KPMAS 患者的年龄大于 JHH 患者（中位数年龄分别为 44 岁和 33 岁），且血红蛋白 SS 疾病的比例较低（分别为 29%和 66%）。在 KPMAS 患者中，85%有任何肺炎球菌疫苗接种的记录，而 JHH 患者中有 87%。在 KPMAS 有资格的 54 名患者中有 21 名和 JHH 有资格的 165 名患者中有 95 名患者开了羟基脲处方。在这两个机构，62%的患者坚持使用羟基脲。诊断编码以及疫苗接种和续药记录存在局限性。