Presentation Details
| Access to Factor VIII and Factor IX to Persons with Hemophilia in Arkansas: A Quality Improvement Study Divyaswathi Citla-Sridhar1, 2, Kara Burge2, Jean Aroom3, Justine Kaplan3, Shelley Crary1, 2. 1University of Arkansas for Medical Sciences, Little Rock, AR, USA.2Arkansas Children’s Hospital, Little Rock, AR, USA.3American Thrombosis and Hemostasis Network, Rochester, NY, USA |
Abstract
Introduction and objectives: Arkansas is ranked 48th in the United States for health, with only one federally supported hemophilia treatment center (HTC) where persons with hemophilia A and hemophilia B (PwH) can get specialized care: the Arkansas Center for Bleeding Disorders at Arkansas Children’s Hospital (“our center”). Within Arkansas, there are a total of 57 designated trauma centers (DTC) for emergency treatment. With several PwH reporting that the emergency room they went to did not have factor available to treat their bleeding episode, this study aimed to identify factor VIII (F8) and factor IX (F9) availability at each of the 57 DTCs across the state of Arkansas and assess the time taken for a PwH to travel to the nearest center with factor availability. Methods: This is a quality improvement (QI) study in collaboration with the National Hemophilia Program Coordinating Center (NHPCC). Using the list of DTCs available from the Arkansas Department of Health, our center’s social worker contacted each center and compiled a list of F8 and F9 products available at each DTC. Using ZIP code information of PwH from a de-identified patient dataset at our center and using geographic information system (GIS), all PwH were mapped and their travel time to a DTC with factor availability was determined. Results: Out of 57 DTCs, F8 was available at 18 centers (Table 1) – 6 Level 1 DTC (100%), 4 level II DTC (100%), 7 level III DTC (38.8%), 1 level IV DTC (3.4%). F9 was available at 10 centers – 6 Level 1 DTC (100%), 1 level II DTC (25%), 2 level III DTC (11.1%), 1 level IV DTC (3.4%). GIS map below (Figure 1) depicts PwH and their distribution in the state of Arkansas in relation to a DTC with factor availability. 30% of hemophilia A and 63.4% of hemophilia B patients lived greater than 1 hour from nearest DTC with factor availability. Conclusions: With less than half of Arkansas’ trauma centers carrying factor replacement therapies, PwH have especially limited access to life-saving factor replacement. By educating community emergency centers, improved health outcomes are possible for PwH through increased access to local emergency treatment centers. As the next step in QI, we have started an education program for DTCs, and we will re-assess factor availability upon completion of this educational effort.
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