Telemedicine for Children With Sickle Cell Disease

Study Overview
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Brief Summary
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The purpose of this study is to learn more about how the use of two different types of telemedicine (distance medical care) can address barriers to receiving comprehensive sickle cell care, and whether care can be improved. Aim 1: Adapt two telemedicine models (i.e., hub-and-spoke; direct-to-consumer) for use with children with SCD using caregiver input from our preliminary K12 work. Aim 2: Demonstrate the feasibility of the telemedicine models developed in Aim 1 as the models undergo successive stakeholder refinement during use in actual clinical care. Aim 3: Evaluate the effectiveness of the refined models from Aim 2 in a pre/post study by assessing (a) process of care measures, (b) provider satisfaction, (c) caregiver/patient-centered outcomes, and (d) clinical outcomes and healthcare utilization.

Official Title
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Telemedicine for Pediatric Sickle Cell Patients in Medically Underserved Areas

Conditions
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Anemia, Sickle Cell

Intervention / Treatment
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* Other: Types of Telemedicine Delivery Models


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Caregivers must be 18 years or older, who have children between 0 to 21 years old with a diagnosis of Sickle Cell Disease and receive care at the Riley Hospital for Children Comprehensive Sickle Cell Disease clinic. Adolescent patients 16 years and older are also able to participate in interviews/surveys. The family must be willing to receive their care using the telemedicine model available to them based on the location of their primary residence. TeleSCD model participants must live within 1 hour of the pre-identified telemedicine sites, while VirtualSCD model participants must live within the city limits of the pre-identified area. Exclusion Criteria: If a patient receives chronic transfusion therapy, they will not be eligible to participate, as our telemedicine models will not support this.

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Hub and Spoke<br> | Other: Types of Telemedicine Delivery Models<br>* Each arm delivers standard sickle cell care using a different model based on patient location.<br>|
| Active Comparator: Direct to Consumer<br> | Other: Types of Telemedicine Delivery Models<br>* Each arm delivers standard sickle cell care using a different model based on patient location.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measuring adherence to appointment in sickle cell care. | Failed appointments in Electronic Medical Record - no more than one failed appointment during pilot year. | 1 year | 
| Measuring adherence to lab draws in sickle cell care. | Adherence to lab draws - a minimum of one complete blood count per six months. | 6 months | 
| Measuring healthcare utilization pre and post telemedicine participation. | Will determine the frequency of 1) vasoocclusive pain episode; 2) acute chest syndrome; 3) Emergency department visits; 4) hospitalizations. This data will be collected through chart abstraction from Electronic Medical Record one year prior to study entry and one year on study. | 1 year | 
| Measuring collaboration of primary care provider and subspecialty care provider. | Documentation of Primary Care Provider communication of visits in the electronic medical record at least 70% of the time. | 1 year | 
| Provider Feedback | Telemedicine Acceptance Questionnaire (TAQ) - will be given to all providers participating in telemedicine visits after every telemedicine visit. 0-5 Likert scale | 1 year | 
| Caregiver feedback | Telemedicine satisfaction survey (TESS) - administered to caregivers following each telemedicine visit. 0-5 Likert scale | 1 year |