Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. 1763-1770 (doi:10.1542/peds.2005-1611)
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SPECIAL ARTICLE

Sickle Cell Disease: A Question of Equity and Quality

Lauren A. Smith, MD, MPHa, Suzette O. Oyeku, MD, MPHb, Charles Homer, MD, MPHc and Barry Zuckerman, MDa

a Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
b Division of General Pediatrics, Children’s Hospital Boston, Boston, Massachusetts
c National Initiative for Children’s Healthcare Quality, Boston, Massachusetts

Thirty years ago, the first major federal legislation concerning sickle cell disease treatment was passed, resulting in the development of comprehensive sickle cell centers. We are now at another watershed moment in the treatment of this illness with the passage in October 2004 of the Sickle Cell Treatment Act, designed to substantially expand specialized sickle cell treatment programs. This legislation offers a remarkable opportunity to significantly improve health outcomes for individuals with sickle cell disease if it is implemented with a specific focus on the distinct but related issues of equity and quality. Despite major advances in sickle cell disease treatment that have occurred over the past 3 decades, important gaps exist both in the equity of government and private philanthropic support for research and in the uniform provision of high quality clinical care. This article assesses the current gaps in funding support and in the implementation of improvements in clinical care in order to suggest strategies for making optimal use of the opportunity that the new legislation presents to improve the health of all individuals affected by this disease.

Abbreviations: SCD—sickle cell disease • NIH—National Institutes of Health • RFA—requests for application • NHLBI—National Heart, Lung, and Blood Institute • AHRQ—Agency for Healthcare Research and Quality

Accepted Oct 17, 2005.


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