Quality improvement initiative to improve pulmonary function in pediatric cystic fibrosis patients
Amy G Filbrun1, Catherine Enochs1, Lindsay Caverly1
1Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan.
Insights
A quality improvement project in Cystic Fibrosis (CF) patients improved lung function. Standardized care plans and patient education led to a significant increase in forced expiratory volume in 1-second (FEV1) percent predicted.
Area of Science:
- Pulmonology
- Pediatric Medicine
- Quality Improvement Science
Background:
- Cystic Fibrosis (CF) affects lung function, necessitating interventions to improve outcomes.
- Quality Improvement (QI) projects are crucial for enhancing patient care in chronic diseases like CF.
- Maintaining optimal lung function, measured by forced expiratory volume in 1-second (FEV1) percent predicted (pp), is a key goal in CF management.
Purpose of the Study:
- To implement a QI project aimed at increasing the mean FEV1 pp by 5% in 12 months for pediatric CF patients (6-21 years) with FEV1 pp ≤ 80%.
- To identify and address barriers to adherence and lung function decline in young CF patients.
- To standardize care delivery across providers for individualized patient treatment plans.
Main Methods:
- Utilized cause and effect diagrams (fishbones) to identify factors contributing to suboptimal FEV1 pp.
- Developed flowcharts to systematically address identified barriers to treatment adherence and lung function improvement.
- Implemented a standardized, individualized care approach for CF patients with FEV1 pp ≤ 80%.
Main Results:
- The project identified a need for enhanced patient/family education and consistent treatment plan delivery at clinic visits.
- After 6 months, mean FEV1 pp improved by 6.4% (CI, 0.4%-12.9%).
- At 12 months, mean FEV1 pp improved by 14% (CI, 6.5%-21.4%), significantly exceeding the 5% goal.
Conclusions:
- A collaborative QI approach involving healthcare teams, patients, and families can effectively improve lung function in pediatric CF patients.
- Standardized care pathways and individualized treatment plans are effective in overcoming barriers to improved FEV1 pp.
- This QI initiative demonstrated a successful strategy for enhancing respiratory health outcomes in young individuals with Cystic Fibrosis.
Background:
Our Cystic Fibrosis (CF) Center initiated a Quality Improvement (QI) project in November 2017 with the goal of improving our patients' forced expiratory volume in 1 second (FEV1) percent predicted (pp) and continued for 1 year. Our specific aim was to increase the relative mean FEV1 pp by 5% in 12 months for CF patients 6 to 21 years old with FEV1 ≤ 80 pp.
Methods:
We identified patients with FEV1 ≤ 80 pp, developed cause and effect diagrams (fishbones) to identify contributing factors to FEV1 ≤ 80 pp, and created flowcharts to address barriers. The barriers to adherence that may result in FEV1 ≤ 80 pp were studied using a fishbone. A standardized approach across providers was implemented to individualize care for each patient. Each discipline developed a flowchart to address barriers to improving FEV1.
Results:
Forty patients were identified (43% male). Their mean age was 16.8 years (range 8.2-21.5 years). Mean FEV1 pp at baseline was 58.6 (range 30-80). The fishbone identified needs for continuing education for patients/families, and providing a treatment plan at each clinic visit. After 6 months of implementation, patients had an improvement in mean FEV1 pp by 6.4% (CI, 0.4%-12.9%). At 12 months, mean FEV1 pp had improved by 14% (CI, 6.5%-21.4%), which exceeded our goal of 5%.
Conclusion:
Through this ongoing project, team members, patients, and families partnered to improve lung function in pediatric CF patients. Flowcharts facilitated a standardized approach across providers to develop individualized treatment plans for patients, which resulted in improved lung function.
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