Impact of a program ensuring consistent response to acute drops in lung function in children with cystic fibrosis
Michael S Schechter1, H Joel Schmidt1, Ron Williams1
1Children's Hospital of Richmond at Virginia Commonwealth University, 1000 East Broad Street, Richmond, VA 23298, USA.
Insights
Implementing a standardized, proactive approach to pulmonary exacerbations in cystic fibrosis (CF) care significantly improved lung function outcomes. This quality improvement program demonstrated rapid, measurable gains in lung function for CF patients.
Area of Science:
- Pulmonary Medicine
- Quality Improvement Science
- Pediatric Healthcare
Background:
- Cystic Fibrosis (CF) pulmonary outcomes vary significantly, influenced by CF Center care quality.
- High-performing CF centers exhibit consistent, proactive management of pulmonary exacerbations.
- A program was developed to standardize and share best practices for CF pulmonary care.
Purpose of the Study:
- To implement and evaluate a standardized pulmonary care program for cystic fibrosis patients.
- To improve pulmonary outcomes through consistent and proactive management of exacerbations.
- To create a shareable quality improvement model for other CF Centers.
Main Methods:
- Reorganization of pediatric CF pulmonary care at Children's Hospital of Richmond.
- Development of a pulmonary algorithm for standardized response to lung function changes.
- Utilization of run charts to track process and outcome measures, focusing on the rolling average of best percent predicted FEV1 (ppFEV1).
Main Results:
- The mean best ppFEV1 increased from 87% to 98% between January 2013 and January 2018.
- Specific improvements noted in younger (6-13 years) and adolescent (13-18 years) age groups.
- The ppFEV1 difference between age groups decreased from 34% to 14% during the study period.
Conclusions:
- Quality improvement principles, including interdisciplinary goal setting and standardized care, rapidly enhance CF pulmonary outcomes.
- Proactive and consistent recognition/treatment of pulmonary exacerbations are key to improvement.
- The developed program is adaptable for implementation in other CF Centers.
Background:
Variation in CF pulmonary outcomes is multifactorial, but a significant component appears to be dependent upon differences in CF Center care. Previous investigations suggest that high performing CF centers are more consistent and proactive in the treatment of pulmonary exacerbations. We incorporated this approach into a program that could be bundled and shared with other CF Centers.
Methods:
The reorganization of CF pulmonary care at the Children's Hospital of Richmond included the development of a pulmonary algorithm to define a standard response to changes in lung function and run charts to track process and outcome measures. We calculated the rolling average of the best percent predicted FEV1 (ppFEV1) over the previous 12 months as our primary outcome measure.
Results:
The mean of the best ppFEV1 in the previous 12 months rose from 87% predicted (65% predicted for those 13-18 years, 97% predicted for those 6-13 years) in January 2013 to 98% predicted (95% predicted for those 13-18 years, 110% predicted for those 6-13 years) in January 2018. The ppFEV1 difference between children 6-13 years and adolescents 13-18 years dropped from 34 to 14 during that time.
Conclusions:
Improvements in pulmonary outcomes can be accomplished rapidly using basic quality improvement principles, including interdisciplinary team goal setting, standardized and proactive approaches that ensure consistent recognition and treatment of pulmonary exacerbations, and the use of data to follow the effectiveness of the process. We believe that the steps involved would be easy for other CF Centers to adapt to their own settings.
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