Abstract WP411: Missed Opportunities for Transcranial Doppler Screening Among Children with Sickle Cell Disease

Abstract

Background: With high healthcare utilization among children with sickle cell disease (SCD) but low rates of Transcranial Doppler (TCD) screening, missed opportunities for TCD screening may be numerous. We sought to quantify missed opportunities among children with SCD and to identify characteristics associated with missed opportunities to help target future interventions. Methods: All children ages 2-16 with SC-SS or SC-Beta Thalessemia were identified in Michigan Medicaid (2007-2010) through newborn screening records. SCD healthcare encounters were assessed for each child during a 2-year interval of continuous enrollment. Healthcare utilization (inpatient, outpatient, ED and hematologist visits) was classified during year one. During year two, we assessed outcomes including receipt of TCD screening and presence of a missed opportunity for TCD screening. A missed opportunity was defined as having at least one SCD healthcare encounter during the outcome interval, but no TCD screening. Each child could have multiple eligible intervals for assessment. Age, gender and SC type were also considered. Logistic regression with generalized estimating equations was used to model the association between a missed opportunity and each individual-level factor. Factors associated with the outcome in bivariable analysis were included in a multivariable model. Results: Overall, there were 240 children with SCD during the study period (50% female, 99% black, 83% SC-SS) in which a total of 551 two-year intervals were eligible for assessment. At least one TCD screening was identified in 21% of eligible time intervals and 18% of children received at least one TCD screening. Missed opportunities occurred in 64% (n=352) of the eligible time intervals. Only age was associated with missed opportunities (OR=1.06, CI:1.01,1.11). The proportions of intervals with missed opportunities among children ages 2-6, 7-11 and 12-16 were 49%, 63% and 71% respectively. Conclusion: In the Michigan Medicaid population, missed opportunities for TCD screening are common among children with SCD and associated with increasing age. Reduction of missed opportunities through physician intervention is a potential strategy to increase TCD screening rates.