Hilltop Researchers Co-Author Study on Limits of Health Communication Letters to Sickle Cell Patients

Hilltop Senior Research Analyst Michael T. Abrams, MPH, and Policy Analyst Carl H. Mueller, MS, are co-authors of a new study published in the Journal of Pediatrics titled Transcranial Doppler Screening of Medicaid-Insured Children with Sickle Cell Disease. The work was conducted in collaboration with researchers at Johns Hopkins and University of South Carolina medical schools under the direction of David G. Bundy, MD.The study found that letters to parents and doctors of children with sickle cell disease (SCD) did not succeed in increasing their use of a simple screening technique (transcranial Doppler imaging: TDI) for stroke risk, even as children with SCD are known to be at markedly heightened risk for stroke. The research, conducted largely at The Hilltop Institute, used Medicaid administrative data to identify a calendar year 2010-2011 cohort of individuals aged 2-16 years with SCD. Researchers measured 6-month post-letter TDI use in a group of 117 subjects whose parents and doctors were sent letters, and in a comparison group of 433 subjects who were not targeted by that mailing. Pre-intervention, annualized screening in the full SCD cohort (n=829) was just over 23 percent. Six-month follow-up on those who did not receive screening in the pre-intervention period was 7.2 percent in the group receiving the mailing and 8.6 percent in the comparison group. This difference was non-significant after adjusting for numerous covariates. Accordingly, this work reveals that a single mailing to parents and providers is not a sufficient method for increasing TDI use in youth with SCD. One important correlate that did emerge from this work is that specialist visits (e.g., to a hematologist) did significantly increase the use of TDI irrespective of the mailing. This incidental finding suggests that referral to a sickle cell specialist is more effective than referral for a specific procedure to address this serious illness, at least in terms of receiving important preventative screening. For more information, contact Hilltop team lead Michael Abrams (mabrams@hilltop.umbc.edu).

The full reference for this work is: Bundy, D. G., Abrams, M. T., Strouse, J. J., Mueller, C. H., Miller, M. R., & Casella, J. F. (2015). Transcranial Doppler screening of Medicaid-insured children with sickle cell disease. Journal of Pediatrics, 166(1), 188-90. doi: 10.1016/j.jpeds.2014.09.018.

The pubmed citation and abstract can be accessed here: http://www.ncbi.nlm.nih.gov/pubmed/25444529

February 17, 2015