Sustained improvement in nutritional outcomes at two paediatric cystic fibrosis centres after quality improvement collaboratives

Savant, Adrienne P.; Britton, LaCrecia J; Petren, Kristofer; McColley, Susanna A.; Gutierrez, Hector

doi:10.1136/bmjqs-2013-002314

Cited by 14 publications

(9 citation statements)

References 16 publications

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“…More broadly, systematic approaches to improving nutritional status have been demonstrated to be sustainable over time in different CF Centers. (22) This is especially pertinent as nearly half of US CF Centers have a median WFL-BMI in the first 6 years of life below the 50 th percentile. (6)…”

Section: Discussionmentioning

confidence: 99%

Early Life Growth Trajectories in Cystic Fibrosis are Associated with Pulmonary Function at Age 6 Years

Sanders

Fink

Mayer-Hamblett

et al. 2015

The Journal of Pediatrics

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Objective To determine whether severity of lung disease at age 6 years is associated with changes in nutritional status before age 6 within individual children with cystic fibrosis (CF). Study Design Children with CF born between 1994 and 2005 and followed in the CF Foundation Patient Registry from age ≤2 through 7 years were assessed according to changes in annualized weight-for-length (WFL) percentiles between ages 0 and 2 and body mass index (BMI) percentiles between ages 2 and 6. The association between growth trajectories before age 6 and forced expiratory volume in one second (FEV1) % predicted at age 6-7 years was evaluated using multivariable linear regression. Results A total of 6,805 subjects met inclusion criteria. Children with annualized WFL-BMI always >50th percentile [N=1,323 (19%)] had the highest adjusted mean [95% Confidence Interval (CI)] FEV1 at 6-7 years [101.8 (100.1, 103.5)]. FEV1 at 6-7 years for children whose WFL-BMI increased >10 percentile points by age 6 years was 98.3 (96.6, 100.0). This was statistically significantly higher than FEV1 for children whose WFL-BMI was stable [94.4 (92.6, 96.2)] or decreased >10 percentile points [92.9 (91.1, 94.8)]. Among children whose WFL-BMI increased >10 percentile points, achieving and maintaining WFL-BMI >50th percentile at younger ages was associated with significantly higher FEV1 at 6-7 years. Conclusions Within-patient changes in nutritional status in the first 6 years of life are significantly associated with FEV1 at age 6-7 years, suggesting that interventions that improve nutrition in early life may lead to improvements in later lung function.

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Section: Discussionmentioning

confidence: 99%

Early Life Growth Trajectories in Cystic Fibrosis are Associated with Pulmonary Function at Age 6 Years

Sanders

Fink

Mayer-Hamblett

et al. 2015

The Journal of Pediatrics

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“…Clinical pathways, also known as care pathways or care maps, are one of the main tools used to improve quality and standardize care processes in healthcare. Implementation of quality improvement programs using such pathways has been shown to reduce treatment variability and lead to improved outcomes . However, there are many barriers to health care providers implementing clinical pathways including: (1) knowledge leading to the development of the care pathway; (2) acceptance of the pathway; and (3) adherence to recommending treatment plans consistent with the clinical pathway.…”

Section: Introductionmentioning

confidence: 99%

Implementation of cystic fibrosis clinical pathways improved physician adherence to care guidelines

Singh

Shelton

Greenberg

et al. 2016

Pediatric Pulmonology

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Introduction There is significant variability in clinical outcomes, including growth and lung function, between the various cystic fibrosis (CF) centers. No specific or unique therapeutic practices have been identified to account for these differences. However, more uniform care within centers was associated with better outcomes. The objective of this study was to implement clinical pathways for diagnosis and treatment of nutritional failure and lung inflammation in order to achieve better health care provider adherence to center-specific, agreed-on practices. Methods Agreed-on clinical pathway treatment plans for both nutrition and lower airway inflammation were implemented on January 1, 2010. The primary outcome measure was to evaluate if patients’ diagnoses and treatments were consistent with the agreed-on clinical pathways. Results The proportion of clinic visits from baseline to 18 months post-intervention where the provider completely followed nutrition clinical pathway increased from 57.72% to 79.49% (p=0.049) and the proportion for lower airway inflammation clinical pathway increased from 65.85% to 86.32% (p=0.035). The use of nutritional diagnosis and documentation of associated clinical pathway in the clinical plan increased from 16.26% to 61.54% and 56.10% to 94.87%, respectively. Similarly, diagnosis of lower airway inflammation and documentation related to their treatment plans increased from 1.63% to 43.59% and 30.08% to 87.18%, respectively. Conclusion Implementation of clinical pathways for nutrition and lower airway inflammation issues resulted in more uniform care of CF patients. Having objective criteria for diagnoses and agreed-on treatment plans for each of those diagnoses allowed for monitoring and individual feedback. Increases in utilization of correct diagnoses and discussion of specific therapeutic interventions in the clinic notes were associated with increased adherence to clinical pathways.

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“…2 QIPs with published results include improving the treatment of inpatient pulmonary exacerbations, 3,4 airway clearance techniques, 4 quarterly visits, 5 and nutritional outcomes. 5,6 These programs were supported by the CF Foundation through the Leadership and Learning Quality Improvement Collaborative. 7 The CF Foundation also supports the development of evidence-based care guidelines.…”

mentioning

confidence: 99%

Improvements in Cystic Fibrosis Quarterly Visits, Lung Function Tests, and Respiratory Cultures

et al. 2015

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Sustained improvement in nutritional outcomes at two paediatric cystic fibrosis centres after quality improvement collaboratives

Cited by 14 publications

References 16 publications

Early Life Growth Trajectories in Cystic Fibrosis are Associated with Pulmonary Function at Age 6 Years

Early Life Growth Trajectories in Cystic Fibrosis are Associated with Pulmonary Function at Age 6 Years

Implementation of cystic fibrosis clinical pathways improved physician adherence to care guidelines

Improvements in Cystic Fibrosis Quarterly Visits, Lung Function Tests, and Respiratory Cultures

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