Hospital Admissions, Emergency Department Visits Decline Following Sickle Cell Education; Savings Estimated at $1.6 Million

CMS Expands Local Memphis Project Nationwide

A Centers for Medicare & Medicaid Services (CMS) special innovation project to improve acute pain management in Sickle Cell Disease (SCD) patients that originated in Memphis, will be expanded to a national scale over the next 12 months.

The project which is a collaborative effort between Qsource, the prime CMS Quality Innovation Network – Quality Improvement Organization (QIN-QIO) contractor for the Qsource, the Sickle Cell Foundation of Tennessee, specialized sickle cell centers and hospitals, emphasizes:

• education of the Emergency Department (ED) staff,
• increasing the availability and use of care plans in the ED,
• improved care coordination between hospitals and sickle cell centers or healthcare providers, and
• addressing cultural stigmas around the disease.

Sickle cell disease is an inherited genetic blood disorder that causes red blood cells to be sickle-shaped instead of round. The sickled shape causes the cells to get stuck, blocking blood vessels and reducing the amount of blood that reaches the body’s tissues and organs. This can lead to acute and chronic pain, pain crisis, progressive organ damage, and death. Pain drives the majority of patient interactions with the healthcare system, particularly the EDs.

Because the disease is rare in the United States, there is a lack of training about appropriate treatment guidelines among those who provide care in the ED which can result in insufficient care. In the United States, it is estimated that SCD affects approximately 100,000 individuals, the majority of whom are African American. About 3,000 people in the Memphis metropolitan area live with  SCD.

In Memphis, Qsource sponsored events that provided education to approximately 300 clinicians and healthcare navigators through face-to-face meetings and on-demand learning webinars. These carefully-planned educational events featured nationally recognized leaders including prominent patient advocate Dominique Friend and Dr. Patricia Kavanagh, a physician and quality improvement expert who has worked with more than 30 hospitals across the country to improve the way SCD patients are cared for in their EDs. Over the course of two days, Kavanagh and Friend worked closely with ED physicians, nurses and hospital leadership from seven acute care hospitals in Memphis to share information about the disease and its unpredictability and current National Heart, Lung and Blood Institute guidelines for acute pain crisis. Qsource also offered a monthly learning series for people with SCD in partnership with the Sickle Cell Foundation of Tennessee. Topics included: proper hydration and stress management; care coordination between various providers; emergency room engagement and visit preparation and self-advocacy. Education to consumers intentionally stressed the benefits of aligning with a medical home and often included information related to resources available through the local SCD centers. This local patient education opportunities will continue.

The work over the past two years has been focused on connecting patients with SCD Centers that deliver high-quality, comprehensive care designed specifically for individuals with SCD. These centers provide patients with more timely pain management services than can typically be given in the ED which has been associated with a decrease in ED visits and inpatient admissions that originate from the ED (S. Lanzkron, P. Carroll, P. Hill, M. David, N. Paul and C. Haywood, “Impact of a Dedicated Infusion Clinic for Acute Management of Adults with Sickle Cell Pain Crisis,” American Journal of Hematology, vol. 90, no. 5, p. 376–380, 25 February 2015). In the two years, since the beginning of the project, 175 new adult patients have been seen in SCD centers.

To evaluate the effects of the work in the Memphis area on reducing avoidable hospital utilization, Qsource identified a cohort of 195 SCD patients who had at least one ED visit, inpatient (IP) hospital admission, or observation hospital visit in 2014 and were present in the 2017 Medicare claims file. Qsource compared the utilization of these patients at baseline (2014) and their utilization in 2017. There were 94 fewer IP admissions, 219 fewer ED visits, and 106 fewer observation stays among the cohort. Based on the average cost of these services in 2017, these reductions resulted in an estimated savings of $1,685,503. Additionally, the proportion of inpatient admissions coming through the ED decreased by 13 percent, to 71 percent and has surpassed the national benchmark of 75 percent.

In the coming months, Qsource will expand the efforts to additional hospitals in the Memphis area. The organization will spread lessons learned locally to hospitals across the country, amplifying the voices of those living with this disease.  Qsource has partnered with the American College of Emergency Physicians (ACEP), which has a current reach of over 37,000 members, and Paula Tanabe, PhD, RN, FAEN, FAAN, Professor of Nursing and Medicine, Duke University. They will conduct educational events emphasizing current treatments, best practices, patient perspectives and innovations in the management of SCD. The group will share information at various ACEP state and regional chapters’ events, as well as through blog posts, podcasts and other communications channels to raise awareness of the disease and current treatment guidelines.

Contact Frances Richardson, Sickle Cell Project Lead, at [email protected] and visit atomAlliance.org for more information.