Network Implementation of Guideline for Early Detection Decreases Age at Cerebral Palsy Diagnosis

Abstract

BACKGROUND AND OBJECTIVES: Early diagnosis of cerebral palsy (CP) is critical in obtaining evidence-based interventions when plasticity is greatest. In 2017, international guidelines for early detection of CP were published on the basis of a systematic review of evidence. Our study aim was to reduce the age at CP diagnosis throughout a network of 5 diverse US high-risk infant follow-up programs through consistent implementation of these guidelines. METHODS:The study leveraged plan-do-study-act and Lean methodologies. The primary outcome was age at CP diagnosis. Data were acquired during the corresponding 9-month baseline and quarterly throughout study. Balancing measures were clinic no-show rates and parent perception of the diagnosis visit. Clinic teams conducted strengths, weaknesses, opportunities, and threats analyses, process flow evaluations, standardized assessments training, and parent questionnaires. Performance of a 3-to 4-month clinic visit was a critical process step because it included a Hammersmith Infant Neurologic Examination, a General Movements Assessment, and standardized assessments of motor function. RESULTS:The age at CP diagnosis decreased from a weighted average of 19.5 (95% confidence interval 16.2 to 22.8) to 9.5 months (95% confidence interval 4.5 to 14.6), with P = .008; 3-to 4-month visits per site increased from the median (interquartile range) 14 (5.2-73.7) to 54 (34.5-152.0), with P , .001; and no-show rates were not different. Parent questionnaires revealed positive provider perception with improvement opportunities for information content and understandability.CONCLUSIONS: Large-scale implementation of international guidelines for early detection of CP is feasible in diverse high-risk infant follow-up clinics. The initiative was received positively by families and without adversely affecting clinic operational flow. Additional parent support and education are necessary.

Protocol and Feasibility-Randomized Trial of Telehealth Delivery for a Multicomponent Upper Extremity Intervention in Infants With Asymmetric Cerebral Palsy

“…Future evaluations using RCTs are necessary to determine whether this highly protocolized approach to upper-extremity intervention can be effective in multiple settings with varied challenges, such as those disclosed by institutions in a clinical network of institutions that implemented early diagnosis of CP guidelines. 47…”

Beyond the First Wave: Consequences of COVID-19 on High-Risk Infants and Families

“…Recent initiatives to integrate standardized motor assessments into high-risk infant follow-up assessments have resulted in shortened time to the diagnosis of cerebral palsy. 36 Importantly, access to highrisk infant follow-up is not uniform; a large, population-based cohort of extremely low birth weight infants demonstrated an association between socioeconomic factors and attendance in high-risk infant follow-up. 37 Programs that offer enhanced support around the transition from the NICU to home can decrease infant rehospitalization rates and overall health care costs.…”

Early detection of cerebral palsy in high‐risk infants: Translation of evidence into practice in an Australian hospital

“…Despite the strong evidence guiding the recommendations, there is little published literature on the implementation of these guidelines into clinical practice. Two studies within the USA have showed that implementation of the recommendations into high‐risk infant follow‐up clinics is both feasible and practical 5,6 . Real‐world results from an Australian setting are important to analyse as the guidelines become more widely implemented.…”