Session: 900. Health Services and Quality Improvement: Hemoglobinopathies: Poster II
Hematology Disease Topics & Pathways:
Clinical Practice (Health Services and Quality), Workforce, Diversity, Equity, and Inclusion (DEI)
Methods: We conducted a multi-site implementation study that included a new dedicated IC at a community hospital (spoke) facilitated by a large, well-established comprehensive care center (hub). This study was approved by the institutional review board across all clinical sites. Funding also supported partnerships with a community-based organization (CBO) that provided community health workers to address social determinates of health (SDOH) and a comprehensive pediatric program which expanded services for transition to adult care. The spoke was staffed by a part-time palliative care trained physician, an advanced practice provider, a nurse and front desk staff. Staff at the spoke were trained by the hub, who also provided weekly supervision from a clinical and operations standpoint. The spoke IC had 6 chairs used both for acute and continuity care Monday through Friday from 9am-5pm. Data on outpatient, inpatient, and ED utilization were collected for adult residents of PGC with SCD from the regional Health Information Exchange (HIE) and the spoke electronic medical record.
Results: From 2022 to 2024, 174 adult patients with SCD were provided clinical care at the spoke. A dedicated adult SCD IC opened at the spoke in March 2023 and during the first 15 months, there were 949 encounters (636 infusion visits for pain, 313 scheduled visits for routine sickle cell care). Only 13 (2%) of the infusion visits resulted in hospital admission. Before the IC opened in 2022, there were 295 ED visits for SCD in the 5 community hospitals in PGC for residents of PGC. The spoke facility accounted for 107 (36%) of these ED visits in 2022. In 2023, total ED visits for SCD in any hospital in the county dropped by 13%, and the proportion seen at the spoke remained 36%. The admission rate from the ED at the spoke facility decreased from 26% prior to the IC opening to 14% after opening. Using aggregate HIE data, outpatient visits (including IC visits) for SCD among PGC residents within their county increased by 377% (61 in 2022, 200 in 2023, projected 500 in 2024), and there was a 41% decrease in inpatient admissions for county residents with SCD in county hospitals with no corresponding increase in hospitalizations outside the county.
Conclusions: The hub and spoke model is an efficient way for the hub to extend its clinical reach to meet the needs of adults living with SCD in underserved areas of the US. Future evaluations will examine whether this model increases use of appropriate disease modifying therapy and patient reported outcomes.
Disclosures: Lanzkron: GBT: Research Funding; HRSA: Research Funding; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy; CSL-Behring: Research Funding; PCORI: Research Funding; Merck: Consultancy; Agios: Membership on an entity's Board of Directors or advisory committees; Pfizer: Other: Stock in Family trust; Takeda: Research Funding; GMI: Consultancy; Pfizer: Consultancy; Bluebird BIo: Membership on an entity's Board of Directors or advisory committees; Teva: Other: Stock in Family trust. Lauriello: PCORI: Research Funding; HRSA: Research Funding. Campbell: Agios: Membership on an entity's Board of Directors or advisory committees; Pfizer: Research Funding.
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