Hilltop Researchers in the Journal of Pediatrics

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 Dr. David Bundy. 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 2010-11 cohort of youth aged 2-16 years with SCD, and measured 6 month post-letter TDI use in a group of 117 subje cts whose parents and doctors were sent letters, and a comparison group of 433 subjects who were not targeted by that mailing. Pre-intervention, annualized screening in the full SCD cohort identified (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 group difference was non-significant after adjusting for numerous covariates. Accordingly, this work reveals that a single mailing to parents and providers is not sufficient to increase TDI use in youth with SCD. One important correlate which did emerge from this work is that specialist visits (e.g., to a hematologist), did significantly increase the use of TCD irrespective of the mailing. This incidental finding suggests that referral to a sickle cell specialist is more impactful 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 DG, Abrams MT, Strouse JJ, Mueller CH, Miller MR, Casella JF (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