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Assessing Adherence to Audiologic Parameters of Care for Children With Cleft Palate: A Quality Improvement Initiative
Ursula M Findlen1,2, Jonathan Grischkan2,3, Sandra Alston1
1Audiology Department, Nationwide Children's Hospital, OH, USA.
Insights
Improving hearing care for children with cleft palate is possible. A quality improvement initiative increased adherence to audiology protocols from 59% to 84% through better access and team communication.
Area of Science:
- Pediatric Audiology
- Cleft Palate Management
- Quality Improvement Science
Background:
- Children with cleft palate have a higher risk of hearing loss.
- Consistent audiological follow-up is crucial for early detection and management of hearing impairments.
- Adherence to established audiological protocols can be challenging in multidisciplinary settings.
Purpose of the Study:
- To evaluate and enhance adherence to an evidence-based audiological management protocol for pediatric cleft palate patients.
- To identify barriers to audiological follow-up and implement targeted interventions.
Main Methods:
- A prospective, multidisciplinary quality improvement initiative was conducted at a tertiary pediatric hospital.
- Interventions included developing a protocol, maximizing access to audiology services, and enhancing team education and communication.
- Adherence was measured by the completion of recommended audiological assessments at five care milestones.
Main Results:
- Adherence to recommended audiological follow-up increased significantly from 59% to 84% between 2016 and 2020.
- Increased access to audiology testing within multidisciplinary cleft team clinics yielded the greatest improvement in adherence.
- Nonadherence attributed to provider-related factors decreased more than patient/family-related factors.
Conclusions:
- Implementing evidence-based audiological care protocols and improving early hearing care access is feasible in high-volume cleft clinics.
- Strategies to enhance access to care, educate team members and families, and improve communication are key to improving adherence.
Objective:
To evaluate and increase adherence to an evidence-based audiologic management protocol for children with cleft palate.
Design:
Prospective, multidisciplinary quality improvement initiative.
Setting:
Tertiary pediatric hospital.
Patients, Participants:
Children with cleft palate (with or without cleft lip) between the ages of 0 and 5 years (n = 205).
Interventions:
A multidisciplinary team identified key drivers for nonadherence to recommended audiological follow-up and implemented interventions to improve adherence. Key drivers included provider practices and preferences, clinic logistics and flow, and patient/family awareness and education. Several interventions were implemented between 2016 and 2020, including developing an evidence-based audiologic protocol, maximizing access to audiologic clinic visits across multiple departments, cleft team education, and improved team communication.
Main Outcome Measure(S):
Completion of recommended audiologic assessment at 5 separate care milestones.
Results:
After implementation of interventions between 2016 and 2020, adherence to recommended audiologic follow-up increased from 59% to 84%. Analysis of individual care milestones revealed that increased access to audiologic testing during team clinics resulted in the largest increase in adherence to recommended follow-up. Additionally, cause-effect analysis revealed that nonadherence due to provider-related causes decreased over the project period to a greater extent than patient/family-related causes.
Conclusions:
Implementation of an evidence-based audiologic care protocol and improvements in access to early hearing care are feasible in a high-volume multidisciplinary cleft clinic. Adherence to recommended audiologic management can be improved by establishing strategies to improve access to care, team member and family education, and enhanced team communication.
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