Quality improvement initiative to improve pulmonary function in pediatric cystic fibrosis patients

Abstract

Background: Our Cystic Fibrosis (CF) Center initiated a Quality Improvement (QI) project in November 2017 with the goal of improving our patients' forced expiratory volume in 1 second (FEV1) percent predicted (pp) and continued for 1 year. Our specific aim was to increase the relative mean FEV1 pp by 5% in 12 months for CF patients 6 to 21 years old with FEV1 ≤ 80 pp. Methods: We identified patients with FEV1 ≤ 80 pp, developed cause and effect diagrams (fishbones) to identify contributing factors to FEV1 ≤ 80 pp, and created flowcharts to address barriers. The barriers to adherence that may result in FEV1 ≤ 80 pp were studied using a fishbone. A standardized approach across providers was implemented to individualize care for each patient. Each discipline developed a flowchart to address barriers to improving FEV1. Results: Forty patients were identified (43% male). Their mean age was 16.8 years (range 8.2-21.5 years). Mean FEV1 pp at baseline was 58.6 (range 30-80). The fishbone identified needs for continuing education for patients/families, and providing a treatment plan at each clinic visit. After 6 months of implementation, patients had an improvement in mean FEV1 pp by 6.4% (CI, 0.4%-12.9%). At 12 months, mean FEV1 pp had improved by 14% (CI, 6.5%-21.4%), which exceeded our goal of 5%. Conclusion: Through this ongoing project, team members, patients, and families partnered to improve lung function in pediatric CF patients. Flowcharts facilitated a standardized approach across providers to develop individualized treatment plans for patients, which resulted in improved lung function.

CF GLOBAL CARE: Collaboration Between Two CF Centers; University of Michigan, USA and Marmara University, Istanbul, Turkey before and during the COVID-19 Pandemic

“…This is due in large part to the close monitoring of FEV1pp and the intervention if there was a drop in FEV1pp according to UoM algorithm. 9 Improvements in FEV1pp are also likely due to teaching pw CF and their families the importance of doing their treatment regularly, adhere to the regularly scheduled visits and learn how to clean their nebulized equipment. In addition, educational material was created and shared with them through classes and virtually.…”

Collaboration between two CF centers; one in USA and one in Turkey before and during CoV2 pandemic

“…Two fishbone diagrams (Figures 1 and 2) were created, to identify the root cause of the low FEV1 and how the FEV1pp was improved. The QI methods used were UMCFC' algorithms and protocols 3,4 . Engaging and educating pwCF and their families as partners in their care through collaboration with KIFDER was crucial to the success of this study.…”

“…The QI methods used were UMCFC' algorithms and protocols. 3,4 Engaging and educating pwCF and their families as partners in their care through collaboration with KIFDER was crucial to the success of this study. With the increase in the dietitian's support, they learned additional evaluation tools for a more in-depth assessment of patients' nutritional status, including pediatric malnutrition criteria.…”

Cystic fibrosis year in review 2020: Section 2 pulmonary disease, infections, and inflammation

“…Organized QI collaboratives, such as the Learning and Leadership Collaboratives (LLCs) and the CF Learning Network, have helped to encourage and spread improvement techniques and initiatives. One such initiative at the University of Michigan emerged through an LLC 2 . They concentrated on patients with FEV1pp values less than 80% in an attempt to improve lung function on the individual level and for the overall outcomes of the center.…”