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Improving Clinical Care for Children with Congenital Hypothyroidism
Shadi Bakjaji1,2, Kathryn Anglin1, Trish Clotts1
1Division of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Insights
A quality improvement initiative successfully increased normal thyroid-stimulating hormone (TSH) levels in children with congenital hypothyroidism (CH). This standardized care approach improved neurocognitive outcomes by ensuring consistent monitoring and timely intervention for pediatric CH patients.
Area of Science:
- Pediatric Endocrinology
- Quality Improvement Science
- Public Health
Background:
- Congenital hypothyroidism (CH) is a common endocrine disorder requiring vigilant management in early childhood to prevent neurocognitive deficits.
- Optimal follow-up care is crucial for children under three with CH to ensure developmental milestones are met.
- Current care pathways may present challenges in consistent monitoring and patient adherence, necessitating quality improvement interventions.
Purpose of the Study:
- To implement and evaluate a quality improvement (QI) initiative aimed at standardizing care for children younger than 3 years with CH.
- To reduce instances of patients lost to follow-up and improve the rate of normalized thyroid-stimulating hormone (TSH) levels.
- To enhance the overall clinical management of pediatric congenital hypothyroidism through a multidisciplinary approach.
Main Methods:
- A multidisciplinary QI team utilized Plan-Do-Study-Act cycles to refine care processes in a pediatric endocrinology clinic.
- Interventions included enhanced case management, standardized caregiver education, and proactive identification of high-risk patients.
- Monthly data collection from electronic medical records tracked patient adherence and TSH levels for a cohort of 74-124 children.
Main Results:
- The QI initiative successfully increased the percentage of patients achieving at least two normal TSH levels within a 12-month period from a baseline of 77% to 94%.
- This improvement in thyroid-stimulating hormone (TSH) normalization was sustained beyond the initial intervention period.
- The project demonstrated a significant enhancement in the consistency of care for pediatric patients with CH.
Conclusions:
- Interdisciplinary collaboration is a key driver for improving clinical care in pediatric congenital hypothyroidism.
- Standardized QI initiatives can effectively enhance monitoring and treatment adherence for CH patients.
- Sustained improvements in TSH levels indicate successful standardization of care and reduced risk of neurocognitive impairment.
Introduction:
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.
Methods:
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.
Results:
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.
Conclusions:
This QI initiative highlights the importance of interdisciplinary collaboration in improving the clinical care of pediatric patients with CH.
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