Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.
Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA.
Pediatr Blood Cancer. 2024 Aug;71(8):e31088. doi: 10.1002/pbc.31088. Epub 2024 May 29.
Individuals with sickle cell disease (SCD) at increased risk for stroke should undergo annual stroke risk assessment using transcranial Doppler (TCD) screening between the ages of 2 and 16. Though this screening can significantly reduce morbidity associated with SCD, screening rates at Boston Children's Hospital (and nationwide) remain below the recommended 100% screening adherence rates.
Three plan-do-study-act (PDSA) cycles were designed and implemented. The Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) aim of our quality improvement (QI) initiative was to sustainably increase the proportion of eligible patients receiving a TCD within 15 months of their last TCD to greater than 95%. An interrupted time series (ITS) analysis was performed, comparing TCD adherence rates from PDSA Cycle 1 to those from PDSA Cycles 2 and 3.
Mean TCD adherence increased across all three PDSA cycles, from a baseline of 67% in the first cycle (January 2015 to September 2020) to 92% in the third cycle (May 2021 to March 2023). In the ITS analysis of TCD adherence rates, there was a significant difference in the final TCD adherence rate achieved compared to the rate predicted, with a total estimated increase in adherence of 17.9% being attributable to the interventions from PDSA Cycles 2 and 3.
Although other QI initiatives had demonstrated ability to increase adherence to TCD screening for patients with SCD, this is the first QI project to collect data over such a prolonged period of time to demonstrate a sustained increase in screening rates throughout the intervention (an 8-year period).
患有镰状细胞病（SCD）且中风风险增加的个体应在 2 至 16 岁期间通过经颅多普勒（TCD）筛查每年进行中风风险评估。尽管这种筛查可以显著降低与 SCD 相关的发病率，但波士顿儿童医院（和全国范围内）的筛查率仍低于建议的 100%筛查依从率。
设计并实施了三个计划-执行-研究-行动（PDSA）循环。我们质量改进（QI）计划的具体、可衡量、可实现、相关和有时限（SMART）目标是可持续地增加在过去 15 个月内接受 TCD 的合格患者比例，使其大于 95%。进行了中断时间序列（ITS）分析，比较了 PDSA 循环 1 与 PDSA 循环 2 和 3 的 TCD 依从率。
所有三个 PDSA 循环的 TCD 依从率均有所提高，从第一个循环（2015 年 1 月至 2020 年 9 月）的基线 67%提高到第三个循环（2021 年 5 月至 2023 年 3 月）的 92%。在 TCD 依从率的 ITS 分析中，与预测率相比，最终 TCD 依从率存在显著差异，归因于 PDSA 循环 2 和 3 的干预措施，总依从率估计增加了 17.9%。
尽管其他 QI 计划已经证明能够提高 SCD 患者对 TCD 筛查的依从性，但这是第一个在如此长的时间内收集数据的 QI 项目，以证明在整个干预期间（8 年期间）筛查率的持续提高。
