Paths Grant: Using the Hub and Spoke Model to Improve Access to Care for Adults Living with Sickle Cell Diseases

• Published in: Blood 2024-11, Vol.144 (Supplement 1), p.3623-3623
• Main Authors: Lanzkron, Sophie, Lauriello, Ashley, Campbell, Andrew D., Morgan-Smith, Vannesia, Zama, Ivan, Robertson, Derek, Barrow, Petronella, Jennings, Jacky, Craig, Taylor, Prince, Elizabeth
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2024-208252

Introduction: Healthcare providers with expertise in sickle cell disease (SCD) are scarce in the United States, particularly in low-income and rural communities. The most common complication of SCD, vaso-occlusive crisis/episode (VOE), often requires treatment in an emergency department (ED) and the administration of intravenous opioid medications. When seeking care in an ED for pain, patients are often labelled as “drug-seeking” and left to suffer, unable to access the expert care they need. Infusion centers (IC) are an evidence-based alternative to ED care and are associated with better outcomes for treatment of uncomplicated VOEs1. It is critical to identify successful implementation strategies to integrate guideline-based care for SCD and to identify providers with the expertise to manage this complex disease close to where patients live. In Prince George's County (PGC), Maryland, there are an estimated 1,550 people living with SCD and no comprehensive adult sickle cell centers. To access high-quality SCD care, patients must travel at least an hour when experiencing a VOE. We describe the implementation of a hub and spoke model with regional adult sickle cell centers to improve access to high quality care for people living with SCD in an underserved region2. Methods: We conducted a multi-site implementation study that included a new dedicated IC at a community hospital (spoke) facilitated by a large, well-established comprehensive care center (hub). This study was approved by the institutional review board across all clinical sites. Funding also supported partnerships with a community-based organization (CBO) that provided community health workers to address social determinates of health (SDOH) and a comprehensive pediatric program which expanded services for transition to adult care. The spoke was staffed by a part-time palliative care trained physician, an advanced practice provider, a nurse and front desk staff. Staff at the spoke were trained by the hub, who also provided weekly supervision from a clinical and operations standpoint. The spoke IC had 6 chairs used both for acute and continuity care Monday through Friday from 9am-5pm. Data on outpatient, inpatient, and ED utilization were collected for adult residents of PGC with SCD from the regional Health Information Exchange (HIE) and the spoke electronic medical record. Results: From 2022 to 2024, 174 adult patients with SCD were provided clinical care at the spoke. A dedicated adult SCD IC open