Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis

Paula Tanabe; Audrey L Blewer; Emily Bonnabeau; Hayden B Bosworth; Denise H Clayton; Nancy Crego; Marian F Earls; Kern Eason; Grayson Forlines; Gary Rains; Matthew Young; Nirmish Shah

doi:10.36469/jheor.2021.21535

Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis

J Health Econ Outcomes Res. 2021 Apr 1;8(1):18-28. doi: 10.36469/jheor.2021.21535.

Authors

Affiliations

¹ School of Nursing, Duke University, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA.
² Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, USA; Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA.
³ School of Nursing, Duke University, Durham, NC, USA.
⁴ School of Nursing, Duke University, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center (DVAMC), Durham, NC, USA.
⁵ RTI International, NC, USA.
⁶ Marian F. Earls Consulting, LLC, Greensboro, NC, USA.
⁷ Previously - Community Care North Carolina, Cary, NC, USA.
⁸ Duke University School of Medicine, Durham, NC, USA.
⁹ Wake Emergency Physicians P.A., Raleigh, NC, USA.

Abstract

Background: Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Individuals with SCD are at high likelihood of high acute care utilization and chronic pain episodes. The multiple complications seen in SCD contribute to significant morbidity and premature mortality, as well as substantial costs to the healthcare system. Objectives: SCD is a complex chronic disease resulting in the need for primary, specialty and emergency care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. We report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). We report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit. Methods: The SCD toolbox was adapted from the National Heart, Lung, and Blood Institute recommendations. Toolbox training was provided to quality improvement specialists who then disseminated the toolbox to primary care providers (PCPs) affiliated with the only NC managed care coordination system and ED providers. Tools were made available in paper, online, and in app formats to participating managed care network practices (n=1 800). Medicaid claims data were analyzed for total costs and benefits of the toolbox dissemination for a 24-month pre- and 18-month post-intervention period. Results: There was no statistically significant shift in the number of outpatient specialty visits, ED visits or hospitalizations. There was a small decrease in the number of PCP visits in the post-implementation period. The dissemination resulted in a net cost-savings of $361 414 ($14.03 per-enrollee per-month on average). However, the estimated financial benefit associated with the dissemination of the SCD toolbox was not statistically significant. Conclusions: Although we did not find the expected shift to increased PCP visits and decreased ED visits and hospitalizations, there were many lessons learned.

Keywords: cost benefit analysis; dissemination; sickle cell; toolkit.

Abstract

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