Bringing Sickle Cell Disease Care Closer to Home: Feasibility and Efficacy of a Quality Improvement Initiative at a Community Hospital

Abstract

Comprehensive care for patients with sickle cell disease has been shown to improve morbidity. However, few studies have focused on community hospitals where the burden of disease is highest. From 2017 to 2019, a series of quality improvement interventions was implemented in Brampton, Toronto, ON, Canada, directed toward pediatric and adult sickle cell disease populations. This included a new adult clinic and education directed at patients and healthcare providers. There were 206 visits from 88 unique patients at the clinic and hydroxyurea (HU) uptake increased from 41.0 to 60.0% over that time (p < 0.001). The annual admission rate by adult patients before and after intervention was 90.0 and 75.0% respectively (p = 0.010). The length of stay of pediatric patients decreased from 3.5 to 2.9 days (p = 0.039). These interventions resulted in significant improvements in acute care utilization and HU use by sickle cell disease patients locally, but larger studies are required to confirm these findings.

Keywords:

• Community medicine
• hydroxyurea (HU)
• patient centered care
• quality improvement
• sickle cell disease

Acknowledgements

The author would like to acknowledge Dr. Richard Ward, Division of Hematology, University Health Network, Toronto, ON, Canada, for setting the example of a center of excellence in care of hemoglobinopathies, and for providing support in development of a community clinic. I would also like to acknowledge the support of patients and families in the continued efforts to improve care of sickle cell disease in Canada.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.