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Screening for Quality of Life in a Neurology Tic Clinic Using Quality Improvement Methodology
Brandon Morgan1, Pedro Weisleder2, Anup D Patel3
1Department of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Quality improvement methods successfully enhanced screening for quality of life (QoL) in pediatric tic disorder patients. Implementing electronic measures significantly increased patient completion rates, improving treatment guidance.
Area of Science:
- Pediatric Neurology
- Quality Improvement Science
- Psychological Assessment
Background:
- Tic disorders in children frequently co-occur with other conditions affecting overall functioning.
- Quality of life (QoL) screening is crucial for identifying effective treatment strategies.
- This study focused on integrating a QoL measure within a neurology clinic setting to guide psychological interventions for tic disorder patients.
Purpose of the Study:
- To describe the implementation of a QoL assessment tool in a pediatric neurology clinic.
- To enhance screening practices for children diagnosed with tic disorders.
- To guide psychological interventions through improved QoL assessment.
Main Methods:
- Utilized Institute for Healthcare Improvement (IHI) quality improvement (QI) methodology.
- Implemented the PedsQL Generic Core (4.0) in an outpatient clinic for tic disorders.
- Employed plan-do-study-act cycles and electronic health record tools to refine the screening process over three years.
Main Results:
- Screened over 350 unique patients during the study period.
- Transitioned from paper-based to electronic QoL measures.
- Achieved a significant increase in patient completion rates, from 0% to 91.6%, sustained for 15 months.
Conclusions:
- QI methodology proved effective in optimizing the implementation of QoL assessments in a busy clinical setting.
- Integrating QoL assessment at the time of appointment facilitated informed treatment and referral decisions.
- Enhanced screening practices through QoL measures support better patient care for tic disorders.
Background:
Tic disorders in children often co-occur with other disorders that can significantly impact functioning. Screening for quality of life (QoL) can help identify optimal treatment paths. This quality improvement (QI) study describes implementation of a QoL measure in a busy neurology clinic to help guide psychological intervention for patients with tics.
Methods:
Using QI methodology outlined by the Institute for Healthcare Improvement, this study implemented the PedsQL Generic Core (4.0) in an outpatient medical clinic specializing in the diagnosis and treatment of tic disorders. Assembling a research team to design process maps and key driver diagrams helped identify gaps in the screening process. Conducting several plan-do-study-act cycles refined identification of patients appropriate to receive the measure. Over the three-year study, electronic health record notification tools and data collection were increasingly utilized to capture patients' information during their visit.
Results:
Over 350 unique patients were screened during the assessment period. Electronic means replaced paper measures as time progressed. The percentage of patients completing the measure increased from 0% to 51.9% after the initial implementation of process improvement, advancing to 91.6% after the introduction of electronic measures. This average completion rate was sustained for 15 months.
Conclusions:
Using QI methodology helped identify the pragmatics of implementing a QoL assessment to enhance screening practices in a busy medical clinic. Assessment review at the time of appointment helped inform treatment and referral decisions.
