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Feasibility and preliminary outcomes of an integrated pediatric sickle cell disease and pulmonary care clinic for children with sickle cell disease
Background In children with sickle cell disease (SCD), comorbid asthma is associated with increased disease severity and morbidity, but it remains underdiagnosed and optimal management paradigms are not well defined. The purpose of this study was to determine the feasibility and preliminary outcomes...
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| Published in: | Pediatric blood & cancer 2020-11, Vol.67 (11), p.e28672-n/a |
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| container_title | Pediatric blood & cancer |
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| creator | Black, L. Vandy Ezmigna, Dima Wallace‐Farquharson, Tanya Wilkie, Diana J. Duckworth, Laurie |
| description | Background
In children with sickle cell disease (SCD), comorbid asthma is associated with increased disease severity and morbidity, but it remains underdiagnosed and optimal management paradigms are not well defined. The purpose of this study was to determine the feasibility and preliminary outcomes of an integrated pediatric SCD and pulmonary care clinic in children with SCD.
Methods
We implemented a pre‐post quality improvement (QI) project in our pediatric hematology clinic between 2017 and 2019. Guided by the chronic care model, patients who were ages 2‐18 years, diagnosed with SCD and suspected pulmonary comorbidities, received care in an interdisciplinary clinic. We examined feasibility and compared clinical outcomes to 24 months prior (2015‐2017) to the implementation of the integrated care model.
Results
Twenty‐four patients were included in the QI project: 88% (n = 21) received pulmonary function testing, 92% (n = 22) were diagnosed with asthma, and 33% (n = 8) with obstructive sleep apnea. Adherence to pulmonary appointments was increased by 81% (mean difference [MD] = 1.3, 95% confidence interval [CI] = 0.71‐1.92; P |
| doi_str_mv | 10.1002/pbc.28672 |
| format | article |
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In children with sickle cell disease (SCD), comorbid asthma is associated with increased disease severity and morbidity, but it remains underdiagnosed and optimal management paradigms are not well defined. The purpose of this study was to determine the feasibility and preliminary outcomes of an integrated pediatric SCD and pulmonary care clinic in children with SCD.
Methods
We implemented a pre‐post quality improvement (QI) project in our pediatric hematology clinic between 2017 and 2019. Guided by the chronic care model, patients who were ages 2‐18 years, diagnosed with SCD and suspected pulmonary comorbidities, received care in an interdisciplinary clinic. We examined feasibility and compared clinical outcomes to 24 months prior (2015‐2017) to the implementation of the integrated care model.
Results
Twenty‐four patients were included in the QI project: 88% (n = 21) received pulmonary function testing, 92% (n = 22) were diagnosed with asthma, and 33% (n = 8) with obstructive sleep apnea. Adherence to pulmonary appointments was increased by 81% (mean difference [MD] = 1.3, 95% confidence interval [CI] = 0.71‐1.92; P < .001). Unplanned acute health care utilization was reduced by 59% (MD = 2.9, 95% CI = 1.14‐4.69; P < .01) and packed red blood cell transfusion was reduced by 81% (MD = 1.38, 95% CI = 0.71‐2.04; P < .001).
Conclusion
Asthma is prevalent in children with SCD, and interdisciplinary clinics can improve access to subspecialty pulmonary care and reduce unplanned acute care. Additional patients and a longer follow‐up period are required to determine the true treatment effect.</description><identifier>ISSN: 1545-5009</identifier><identifier>EISSN: 1545-5017</identifier><identifier>DOI: 10.1002/pbc.28672</identifier><identifier>PMID: 32886403</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Anemia, Sickle Cell - complications ; Apnea ; Asthma ; Asthma - etiology ; Asthma - therapy ; Blood transfusion ; Child ; Child, Preschool ; Children ; Delivery of Health Care, Integrated - methods ; Erythrocytes ; Feasibility Studies ; Female ; Follow-Up Studies ; Hematology ; Humans ; integrated chronic care model ; Interdisciplinary aspects ; Lung diseases ; Male ; Morbidity ; Oncology ; Patient Care Team - standards ; Patients ; Pediatrics ; Prognosis ; quality ; Quality control ; Quality Improvement - standards ; Respiratory function ; Respiratory Function Tests ; Sickle cell disease ; Sleep ; Sleep disorders</subject><ispartof>Pediatric blood & cancer, 2020-11, Vol.67 (11), p.e28672-n/a</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3532-7e7518c2694b729eecb8e06c57e5ad5cab34f1e5cb1f06cc30f20d49c66cdde73</citedby><cites>FETCH-LOGICAL-c3532-7e7518c2694b729eecb8e06c57e5ad5cab34f1e5cb1f06cc30f20d49c66cdde73</cites><orcidid>0000-0003-2712-9595</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32886403$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Black, L. Vandy</creatorcontrib><creatorcontrib>Ezmigna, Dima</creatorcontrib><creatorcontrib>Wallace‐Farquharson, Tanya</creatorcontrib><creatorcontrib>Wilkie, Diana J.</creatorcontrib><creatorcontrib>Duckworth, Laurie</creatorcontrib><title>Feasibility and preliminary outcomes of an integrated pediatric sickle cell disease and pulmonary care clinic for children with sickle cell disease</title><title>Pediatric blood & cancer</title><addtitle>Pediatr Blood Cancer</addtitle><description>Background
In children with sickle cell disease (SCD), comorbid asthma is associated with increased disease severity and morbidity, but it remains underdiagnosed and optimal management paradigms are not well defined. The purpose of this study was to determine the feasibility and preliminary outcomes of an integrated pediatric SCD and pulmonary care clinic in children with SCD.
Methods
We implemented a pre‐post quality improvement (QI) project in our pediatric hematology clinic between 2017 and 2019. Guided by the chronic care model, patients who were ages 2‐18 years, diagnosed with SCD and suspected pulmonary comorbidities, received care in an interdisciplinary clinic. We examined feasibility and compared clinical outcomes to 24 months prior (2015‐2017) to the implementation of the integrated care model.
Results
Twenty‐four patients were included in the QI project: 88% (n = 21) received pulmonary function testing, 92% (n = 22) were diagnosed with asthma, and 33% (n = 8) with obstructive sleep apnea. Adherence to pulmonary appointments was increased by 81% (mean difference [MD] = 1.3, 95% confidence interval [CI] = 0.71‐1.92; P < .001). Unplanned acute health care utilization was reduced by 59% (MD = 2.9, 95% CI = 1.14‐4.69; P < .01) and packed red blood cell transfusion was reduced by 81% (MD = 1.38, 95% CI = 0.71‐2.04; P < .001).
Conclusion
Asthma is prevalent in children with SCD, and interdisciplinary clinics can improve access to subspecialty pulmonary care and reduce unplanned acute care. Additional patients and a longer follow‐up period are required to determine the true treatment effect.</description><subject>Adolescent</subject><subject>Anemia, Sickle Cell - complications</subject><subject>Apnea</subject><subject>Asthma</subject><subject>Asthma - etiology</subject><subject>Asthma - therapy</subject><subject>Blood transfusion</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Delivery of Health Care, Integrated - methods</subject><subject>Erythrocytes</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematology</subject><subject>Humans</subject><subject>integrated chronic care model</subject><subject>Interdisciplinary aspects</subject><subject>Lung diseases</subject><subject>Male</subject><subject>Morbidity</subject><subject>Oncology</subject><subject>Patient Care Team - standards</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Prognosis</subject><subject>quality</subject><subject>Quality control</subject><subject>Quality Improvement - standards</subject><subject>Respiratory function</subject><subject>Respiratory Function Tests</subject><subject>Sickle cell disease</subject><subject>Sleep</subject><subject>Sleep disorders</subject><issn>1545-5009</issn><issn>1545-5017</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kU1LxDAQhoMofh_8AxLwoofVNG2a9qiLXyDoQc8lnUw1mjZr0iL7O_zDZrerB9FThswzD8O8hBwk7DRhjJ_NajjlRS75GtlORCYmgiVy_adm5RbZCeE1ojkTxSbZSnlR5BlLt8nnFapgamNNP6eq03Tm0ZrWdMrPqRt6cC0G6prYo6br8dmrHiOF2qjeG6DBwJtFCmgt1SZEG46ewbZuaQHlY9-aLtKN8xRejNUeO_ph-pe_5vfIRqNswP3Vu0ueri4fpzeTu_vr2-n53QRSkfKJRCmSAnheZrXkJSLUBbIchEShtABVp1mToIA6aeI3pKzhTGcl5DlojTLdJcejd-bd-4Chr1oTFouoDt0QKp5lLJOMpUVEj36hr27wXdxuQYlCypKzSJ2MFHgXgsemmnnTxhtUCasWSVUxqWqZVGQPV8ahblH_kN_RROBsBD6Mxfn_purhYjoqvwD5W5_X</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Black, L. Vandy</creator><creator>Ezmigna, Dima</creator><creator>Wallace‐Farquharson, Tanya</creator><creator>Wilkie, Diana J.</creator><creator>Duckworth, Laurie</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2712-9595</orcidid></search><sort><creationdate>202011</creationdate><title>Feasibility and preliminary outcomes of an integrated pediatric sickle cell disease and pulmonary care clinic for children with sickle cell disease</title><author>Black, L. Vandy ; Ezmigna, Dima ; Wallace‐Farquharson, Tanya ; Wilkie, Diana J. ; Duckworth, Laurie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3532-7e7518c2694b729eecb8e06c57e5ad5cab34f1e5cb1f06cc30f20d49c66cdde73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Anemia, Sickle Cell - complications</topic><topic>Apnea</topic><topic>Asthma</topic><topic>Asthma - etiology</topic><topic>Asthma - therapy</topic><topic>Blood transfusion</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Delivery of Health Care, Integrated - methods</topic><topic>Erythrocytes</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hematology</topic><topic>Humans</topic><topic>integrated chronic care model</topic><topic>Interdisciplinary aspects</topic><topic>Lung diseases</topic><topic>Male</topic><topic>Morbidity</topic><topic>Oncology</topic><topic>Patient Care Team - standards</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Prognosis</topic><topic>quality</topic><topic>Quality control</topic><topic>Quality Improvement - standards</topic><topic>Respiratory function</topic><topic>Respiratory Function Tests</topic><topic>Sickle cell disease</topic><topic>Sleep</topic><topic>Sleep disorders</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Black, L. Vandy</creatorcontrib><creatorcontrib>Ezmigna, Dima</creatorcontrib><creatorcontrib>Wallace‐Farquharson, Tanya</creatorcontrib><creatorcontrib>Wilkie, Diana J.</creatorcontrib><creatorcontrib>Duckworth, Laurie</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric blood & cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Black, L. Vandy</au><au>Ezmigna, Dima</au><au>Wallace‐Farquharson, Tanya</au><au>Wilkie, Diana J.</au><au>Duckworth, Laurie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Feasibility and preliminary outcomes of an integrated pediatric sickle cell disease and pulmonary care clinic for children with sickle cell disease</atitle><jtitle>Pediatric blood & cancer</jtitle><addtitle>Pediatr Blood Cancer</addtitle><date>2020-11</date><risdate>2020</risdate><volume>67</volume><issue>11</issue><spage>e28672</spage><epage>n/a</epage><pages>e28672-n/a</pages><issn>1545-5009</issn><eissn>1545-5017</eissn><abstract>Background
In children with sickle cell disease (SCD), comorbid asthma is associated with increased disease severity and morbidity, but it remains underdiagnosed and optimal management paradigms are not well defined. The purpose of this study was to determine the feasibility and preliminary outcomes of an integrated pediatric SCD and pulmonary care clinic in children with SCD.
Methods
We implemented a pre‐post quality improvement (QI) project in our pediatric hematology clinic between 2017 and 2019. Guided by the chronic care model, patients who were ages 2‐18 years, diagnosed with SCD and suspected pulmonary comorbidities, received care in an interdisciplinary clinic. We examined feasibility and compared clinical outcomes to 24 months prior (2015‐2017) to the implementation of the integrated care model.
Results
Twenty‐four patients were included in the QI project: 88% (n = 21) received pulmonary function testing, 92% (n = 22) were diagnosed with asthma, and 33% (n = 8) with obstructive sleep apnea. Adherence to pulmonary appointments was increased by 81% (mean difference [MD] = 1.3, 95% confidence interval [CI] = 0.71‐1.92; P < .001). Unplanned acute health care utilization was reduced by 59% (MD = 2.9, 95% CI = 1.14‐4.69; P < .01) and packed red blood cell transfusion was reduced by 81% (MD = 1.38, 95% CI = 0.71‐2.04; P < .001).
Conclusion
Asthma is prevalent in children with SCD, and interdisciplinary clinics can improve access to subspecialty pulmonary care and reduce unplanned acute care. Additional patients and a longer follow‐up period are required to determine the true treatment effect.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32886403</pmid><doi>10.1002/pbc.28672</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-2712-9595</orcidid></addata></record> |
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| subjects | Adolescent Anemia, Sickle Cell - complications Apnea Asthma Asthma - etiology Asthma - therapy Blood transfusion Child Child, Preschool Children Delivery of Health Care, Integrated - methods Erythrocytes Feasibility Studies Female Follow-Up Studies Hematology Humans integrated chronic care model Interdisciplinary aspects Lung diseases Male Morbidity Oncology Patient Care Team - standards Patients Pediatrics Prognosis quality Quality control Quality Improvement - standards Respiratory function Respiratory Function Tests Sickle cell disease Sleep Sleep disorders |
| title | Feasibility and preliminary outcomes of an integrated pediatric sickle cell disease and pulmonary care clinic for children with sickle cell disease |
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