title: Missed Opportunities for Transcranial Doppler Screening Among Children With Sickle Cell Disease.
abstract: Transcranial Doppler (TCD) screening rates remain low among children with sickle cell disease (SCD). We assessed TCD screening rates and missed opportunities for TCD screening. Children 2 to 16 years old with SCD enrolled in Michigan Medicaid for ≥1 year (2007-2011) were identified through newborn screening. Receipt of TCD screening and presence of a missed opportunity (≥1 SCD-related outpatient visit, no TCD screening) were identified through administrative claims. Potential correlates of missed opportunities included SCD-related health services, comorbidities, and demographics. Logistic regression with generalized estimating equations modeled associations between a missed opportunity and correlates. Overall, 353 children contributed 1066 person-years. TCD screening was low yearly (10%-32%); missed opportunities occurred in 73% of the person-years. Increasing age (odds ratio [OR] = 1.11; confidence interval CI = 1.07, 1.15), previous TCD screening (OR = 0.26; CI = 0.16, 0.41), and 4 to 5 (OR = 0.48; CI = 0.26, 0.87) or ≥6 outpatient visits (OR = 0.26; CI = 0.14, 0.49) were associated with a missed opportunity. Reduction of missed opportunities is a potential strategy to increase TCD screening rates.
authors.affiliation: University of Michigan School of Public Health, Ann Arbor, MI, USA University of Michigan, Department of Pediatrics, Ann Arbor, MI, USA sleasure@umich.edu.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Reeves
authors.affiliation: University of California-San Francisco, Department of Neurology, CA, USA.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Fullerton
authors.affiliation: University of Michigan, Department of Pediatrics, Ann Arbor, MI, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Cohn
authors.affiliation: University of Michigan, Department of Pediatrics, Ann Arbor, MI, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Dombkowski
authors.affiliation: University of Michigan School of Public Health, Ann Arbor, MI, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Boulton
authors.affiliation: University of Michigan School of Public Health, Ann Arbor, MI, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Braun
authors.affiliation: University of Michigan School of Public Health, Ann Arbor, MI, USA University of Michigan, Department of Neurology, Ann arbor, MI, USA.
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Lisabeth
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000000981:diagnostic imaging*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D002550:Cerebral Veins / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D011237:Predictive Value of Tests; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D017585:Ultrasonography, Doppler, Transcranial / Q000706:statistics & numerical data*; D014481:United States
keywords: Medicaid; children; health services research; newborn screening; pediatric stroke; sickle cell disease; stroke prevention; transcranial Doppler screening