Sustained improvement in nutritional outcomes at two paediatric cystic fibrosis centres after quality improvement
Adrienne P Savant1, LaCrecia J Britton, Kristofer Petren
1Department of Pediatrics, Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, , Chicago, Illinois, USA.
Insights
Quality improvement (QI) methodology significantly enhanced nutritional outcomes in pediatric cystic fibrosis (CF) patients. Implementing CF Foundation guidelines through QI fostered sustained improvements in BMI percentiles and overall patient health.
Area of Science:
- Pediatric Nutrition
- Quality Improvement Science
- Cystic Fibrosis Management
Background:
- Pediatric cystic fibrosis (CF) patients often face nutritional challenges impacting health outcomes.
- Effective nutritional management is crucial for improving the quality of life and prognosis in CF patients.
- Previous approaches to nutritional care in CF required enhanced strategies for sustained positive results.
Purpose of the Study:
- To characterize the implementation of quality improvement (QI) methodology for achieving sustained improvements in nutritional outcomes among pediatric CF patients.
- To describe the role of QI in enhancing the application of CF Foundation (CFF) nutrition practice guidelines.
- To evaluate the impact of QI interventions on body mass index (BMI) percentiles in pediatric CF populations.
Main Methods:
- A retrospective analysis of QI interventions applied in two academic pediatric CF programs.
- Utilized data from the CF Foundation (CFF) Patient Data Registry, including all pediatric patients.
- Employed run charts and statistical process control charts to track BMI percentiles and analyzed data using Mann-Whitney U and chi-squared tests.
Main Results:
- Both participating centers demonstrated rapid improvements in mean BMI percentile following QI implementation.
- Nutritional outcomes were sustained over time, with significant increases in BMI percentiles observed years after initial intervention.
- QI methodology, data-driven decision-making, and a cultural shift towards continuous improvement were key to achieving lasting results.
Conclusions:
- Collaborative participation and the application of QI methodology are effective in improving nutritional outcomes for pediatric CF patients.
- A robust quality improvement culture within healthcare institutions is essential for sustaining positive changes in patient care and outcomes.
Objective:
To describe the characteristics of sustained improved nutritional outcomes through the use of quality improvement (QI) methodology.
Design:
Retrospective analysis of a QI intervention in two institutions, implemented as part of larger national collaboratives.
Setting:
Paediatric cystic fibrosis (CF) programmes in academic centres in Alabama and Illinois.
Participants:
All paediatric patients enrolled in the CF Foundation (CFF) Patient Data Registry were included.
Interventions:
Improved and sustained nutrition outcomes occurred through implementation of the CFF practice guidelines for CF nutrition management via care delivery processes, nutritional interventions, team engagement and data display.
Measurement:
Mean body mass index (BMI) percentile, percentage of patients less than 50th percentile and percentage less than 10th percentile for all patients aged 2-20 years were tracked through run charts and statistical process control charts. Mann-Whitney U and χ(2) tests were used to determine significance between each centre and national outcomes.
Results:
Each centre achieved rapid improvement in mean BMI percentile in patients, one centre rising from the 40th percentile in 2001 to the 49th percentile in 2003, the other rising from the 37th percentile in 2003 to the 45th percentile in 2004. These centres have also maintained improved nutritional outcomes, so that they were at the 60th and 55th percentiles, respectively, in 2011. Sustained improvement was accomplished through QI methodology, use of data as a driver for improvement and a change in culture.
Conclusions:
Participation in collaboratives led to improved nutrition outcomes while a strong culture of QI facilitated sustained improvement.
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