Final Research Report
View this project's final research report.
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Related PCORI Dissemination and Implementation Project
Article Highlight: Findings from this PCORI-funded study published in the Annals of Internal Medicine show promise for improving care of individuals living with sickle cell disease (SCD) in the United States, who historically have been underserved by the medical community. Researchers compared treatment for patients with uncomplicated vaso-occlusive crisis (VOC) in emergency rooms (ERs) and infusion centers. VOC is the most prevalent SCD complication and causes acute, excruciating pain that most commonly is treated in ERs. Patients receiving care in infusion centers reported waiting less time—about half as long—for pain medicine than ER patients. They also were more likely to receive care adhering to guidelines for the management of acute pain and less likely to be admitted to the hospital.
Results of This Project
Related Journal Citations
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers noted that the researchers suggest that care in emergency departments (ED) may be hampered by ED providers’ limited knowledge of individual patients. The reviewers wondered if sites participating in the study used individualized care plans, either in the ED or in the infusion centers (IC). The researchers said the treatment sites did not have individualized treatment plans for all patients but said patient-specific treatment plans are typically not available in ED settings. The researchers noted that the study did not strive to compare the use of patient-specific treatment plans in ED versus IC settings.
- The reviewers commented that the researchers did not report on length of visits and that differences in time spent in the IC or ED may have contributed to differences in hospital admission rates, perhaps because ED did not have the resources to keep patients for as long. The researchers added mean and median lengths of time subjects spent in both settings and noted that subjects spent more time in ED settings than in IC settings. The researchers said a more detailed evaluation of how time spent in care sites affected outcomes will be done in the future.
- The reviewers noted that the researchers did not collect data for multiple visits within the same month, which probably led to an underestimate of ongoing crises, a major reason for returning ED patients and readmission. The researchers added this consideration to their study limitations, but also noted that their sensitivity analyses did not find significant differences in outcomes for the high utilizer population, or the individuals most likely to experience multiple ED visits or readmissions in one month.
- The reviewers asked for more detail on the study’s reported use of the last-observation-carried-forward analysis technique to account for missing data. The researchers explained that they only used this method of imputing missing values for information on whether there was a change in medical history between acute care visits. For their primary and secondary outcomes, which had very low missing data rates, the researchers used complete case analysis rather than imputing outcomes.
Conflict of Interest Disclosures
- Has Results