The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Perspectives

CME Article: Improving Inpatient Care for Individuals with Sickle Cell Disease Using the Project ECHO Model

Authors: Rosalyn W. Stewart, MD, MS, Lauren N. Whiteman, MPH, John J. Strouse, MD, PhD, C. Patrick Carroll, MD, Sophie Lanzkron, MD, MHS

Abstract

Sickle cell disease (SCD) is an inherited red blood cell disorder that affects approximately 100,000 people in the United States.1 The hallmark of SCD is vaso-occlusive crisis, which often results in emergency department (ED) visits and hospitalization. Rapid assessment and treatment of vaso-occlusive crisis, close monitoring, social services support, and individualized care can improve outcomes.2–5 Lack of comprehensive coordinated care has led to a significant financial burden of care in terms of avoidable ED visits, acute hospitalizations, and acute care utilization. The acute care utilization rate for those with SCD is 2.67 visits per patient per year.6 Preventing avoidable utilization is possible if patients with SCD have access to knowledgeable providers as well as coordinated, comprehensive care.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Hassell KL. Population estimates of sickle cell disease in the U.S. Am J Prev Med 2010;38(4 suppl):S512-S521.
 
2. Imbach P. Day hospital versus inpatient management: an economic initiative of a pediatric center, examplified on uncomplicated vaso-occlusive crises of children with sickle cell disease. Pediatr Blood Cancer 2008;51:317.
 
3. Raphael JL, Kamdar A, Beavers MB, et al. Treatment of uncomplicated vaso-occlusive crises in children with sickle cell disease in a day hospital. Pediatr Blood Cancer 2008;51:82-85.
 
4. Adewoye AH, Nolan V, McMahon L, et al. Effectiveness of a dedicated day hospital for management of acute sickle cell pain. Haematologica 2007;92:854-855.
 
5. Wright J, Bareford D, Wright C, et al. Day case management of sickle pain: 3 years experience in a UK sickle cell unit. Br J Haematol 2004;126:878-880.
 
6. Brousseau DC, Owens PL, Mosso AL, et al. Acute care utilization and rehospitalizations for sickle cell disease. JAMA 2010;303:1288-1294.
 
7. Grosse SD, Schechter MS, Kulkarni R, et al. Models of comprehensive multidisciplinary care for individuals in the United States with genetic disorders. Pediatrics 2009;123:407-412.
 
8. Brawley OW, Cornelius LJ, Edwards LR, et al. National Institutes of Health Consensus Development Conference statement: hydroxyurea treatment for sickle cell disease. Ann Intern Med 2008;148:932-938.
 
9. Mainous AG, 3rd Tanner RJ, Harle CA, et al. Attitudes toward management of sickle cell disease and its complications: a national survey of academic family physicians. Anemia 2015;2015:853835.
 
10. Whiteman LN, Haywood C, Jr Lanzkron S, et al. Primary care providers’ comfort levels in caring for patients with sickle cell disease. South Med J 2015;108:531-536.
 
11. Haywood C, Jr Beach MC, Lanzkron S, et al. A systematic review of barriers and interventions to improve appropriate use of therapies for sickle cell disease. J Natl Med Assoc 2009;101:1022-1033.
 
12. Elander J, Midence K. A review of evidence about factors affecting quality of pain management in sickle cell disease. Clin J Pain 1996;12:180-193.
 
13. Wright K, Adeosum O. Barriers to effective pain management in sickle cell disease. Br J Nurs 2009;18:158-161.
 
14. Stewart R, Whiteman L. Diminishing bias in sickle cell disease. Med Teach 2013;35:522.
 
15. Maxwell K, Streetly A, Bevan D. Experiences of hospital care and treatment seeking for pain from sickle cell disease: qualitative study. BMJ 1999;318:1585-1590.
 
16. Hamideh D, Alvarez O. Sickle cell disease related mortality in the United States (1999-2009). Pediatr Blood Cancer 2013;60:1482-1486.
 
17. Quinn CT, Rogers ZR, McCavit TL, et al. Improved survival of children and adolescents with sickle cell disease. Blood 2010;115:3447-3452.
 
18. Lanzkron S, Carroll CP, Hill P, et al. Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis. Am J Hematol 2015;90:376-380.
 
19. Arora S, Geppert CM, Kalishman S, et al. Academic health center management of chronic diseases through knowledge networks: Project ECHO. Acad Med 2007;82:154-160.
 
20. Arora S, Kalishman S, Dion D, et al. Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff (Millwood) 2011;30:1176-1184.
 
21. Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med 2011;364:2199-2207.