Improving Clinical Care for Children with Congenital Hypothyroidism

Congenital hypothyroidism (CH) is a common endocrine disorder that requires optimal management and intensive follow-up to prevent neurocognitive impairment, especially within the first 3 years of life.

We implemented a quality improvement (QI) initiative to standardize care and reduce loss to follow-up for children younger than 3 years with CH. The project was conducted in a pediatric endocrinology clinic at a large tertiary hospital in the Midwestern United States from January 2021 to December 2024. The primary aim was to increase the percentage of patients younger than 3 years with CH who achieved 2 or more normal thyroid-stimulating hormone (TSH) levels within a rolling 12-month period, from a baseline of 77% to a goal of greater than 95%. A multidisciplinary QI team-endocrinologists, nurses, social workers, administrative staff, a certified QI specialist, and care coordinators-used Plan-Do-Study-Act cycles to optimize care. Data were collected monthly from the electronic medical record to identify patients who did not meet TSH targets or missed clinic visits. Key interventions included case management, standardized caregiver education, and identification of high-risk patients. The monthly cohort consisted of 74-124 children younger than 3 years with CH.

After 12 months of intervention, this initiative increased the percentage of unique patients younger than 3 years with CH who achieved 2 normal TSH values within a rolling 12-month period, from a baseline of 77%-94%-an improvement that has been sustained.

This QI initiative highlights the importance of interdisciplinary collaboration in improving the clinical care of pediatric patients with CH.