Kudos to Nancy Crego, assistant professor, and her research team for the submission of her AHRQ COVID-19 related application entitled: “Alterations in Sickle Cell Disease Health Care Delivery, Utilization and Cost by North Carolina Medicaid Enrollees throughout the COVID-19 Crisis.” This proposal is in response to RFA-HS-20-003 requesting funds for a two-year period with a start date of September 1, 2020. The objective of this project is to understand how COVID-19 has disproportionately affected health care utilization patterns for individuals with SCD in NC when compared to a sample of NC Medicaid enrollees without SCD.

African Americans, especially those with chronic conditions, are vulnerable to the COVID-19 infection and have a high risk for morbidity and mortality. Sickle cell disease (SCD) predominately affects blacks and is the most common inherited hemoglobinopathy in the United States (US). North Carolina (NC) is one of only four states with the highest SCD prevalence and proportion of Medicaid SCD enrollees.  SCD is associated with multiple complications including immune compromise, painful vaso-occlusive episodes (VOEs), chronic pain, asthma, renal failure, and acute chest syndrome, all of which increase the risk from COVID-19. Acute VOE and chronic pain are leading causes of high acute care utilization in both emergency department (ED) and inpatient settings. High utilization contributes to an estimated $460,000 total lifetime cost of care per SCD patient. Therefore, routine SCD care requires frequent monitoring and ambulatory visits.

Prior to COVID-19, our research team identified complex health care utilization in NC Medicaid enrollees diagnosed with SCD.  People with SCD are at high-risk from COVID-19 infections due to the medical complexity of their diagnosis and because they are a population with numerous documented health care disparities. Early studies indicate there are racial disparities in COVID-19 severity and mortality in counties with large black populations. In addition, ambulatory and ED visits overall have declined due to the pandemic, which could result in serious adverse health outcomes. Thus, it is important to better understand the COVID-19 impact on care delivery for patients with SCD, including how new telehealth visit guidelines have changed health care utilization patterns and costs. It is also important to examine the feasibility, acceptability and adaptations SCD health care providers and patients experienced in the transition to telehealth visits.

Prior research suggests medical care via telehealth is feasible for adults with SCD in rural regions. However, we do not understand the impact of these recommendations in care delivery practices, health care utilization patterns and cost.