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

Characteristics of Quality Improvement Projects in Health Services: A Systematic Scoping Review

OBJECTIVE

Current QI reports within the literature frequently fail to provide enough information regarding interventions, and a significant number of publications do not mention the utilization of a guiding model or framework. The objective of this scoping review was to synthesize the characteristics of hospital-based QI interventions and assess their alignment with recommended quality goals.

METHODS

This scoping review followed the JBI methodology for scoping reviews to synthesize existing literature on hospital-based QI interventions and reporting using the PRISMA Extension for scoping reviews. Included studies involved a hospital-based QI intervention that was evaluated through the Development of the Quality Improvement Minimum Quality Criteria Set (QI-MQCS) framework, reporting on hospital users' (i.e., practitioners and patients) data. We searched Medline, CINAHL, Embase and PubMed databases for primary research published between 2015 and 2024. Grey literature was also examined. A narrative synthesis guided the integration of findings.

RESULTS

From 1398 identified records, 70 relevant records were included. Results indicate a wide variation in QI frameworks and methods used by the included studies. The QI interventions most frequently assessed were organizational-focused (n = 59), followed by professional-related interventions (n = 41) and patient-care interventions (n = 24). There were multiple facilitators and barriers across organizational, professional, and patient care levels found in the included studies. Examples of facilitators were instrumental in driving successful QI initiatives included education, training, active leadership, and stakeholder engagement. Conversely, barriers such as time constraints, resource limitations, and resistance were highlighted.

CONCLUSION

Existing QI publications lack sufficient detail to replicate interventions. Using a model or framework to guide the conduct of a QI-activity may support a more robustly designed and well-conducted project. The variation of reporting characteristics suggests that future research should focus on the development of a pragmatic tool for use by front-line clinicians to support consistent and rigorous conduct of QI projects.

Implementation of standardized cystic fibrosis care algorithm to improve the center data-quality improvement project international collaboration

BACKGROUND

A collaboration between the University of Michigan (U of M) Cystic Fibrosis Center (CFC) and Marmara University (MU) CFC was initiated to improve the health status of people with cystic fibrosis (pwCF) at MU through implementing Quality Improvement (QI) initiatives. The main aim was to improve lung function in children with FEV1pp <80. The secondary aim was to assess the changes in health related quality of life.

METHODS

Included in the project were pwCF who received cystic fibrosis (CF) care at the MU CFC and were 6-18 years of age with an FEV1pp <80. Flow charts were created and a standardized CF care algorithm was implemented. Weekly case review were done to develop individualized treatment plans. Appropriate intervention was applied and patient data were assessed at baseline, 3, 6, 9 and 12 months. The Cystic Fibrosis Revised Questionnaire (CFQ-R) was completed.

RESULTS

55 pwCF were included (mean age:11.8 ± 3.3 years). Mean FEV1pp (SD) at baseline, 6 and 12 month was 63.7 (14.6), 66.9 (16.6), 70.4 (19.2), respectively, with a relative increase of 5.0% in 6 months (p:0.002) and 10.5% in 12 months compared to baseline (p<0.001). Physical functioning, eating problems and respiratory symptoms domains of the CFQ-R questionnaire were improved at the end of the one year for 6-13 (p = 0.024, p = 0.009, p = 0.002) and 13-18 year olds (p = 0.013, p = 0.002, p = 0.038).

CONCLUSION

There was significant improvement in pwCF with FEV1<80%pp after implementing this QI project. The processes and assessments used can be adopted by other low-middle income countries to improve similar measures.

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

The outlook for those with cystic fibrosis (CF) has never been brighter with ever increasing life expectancy and the approval of the highly effective CFTR modulators, such as elexacaftor/tezacaftor/ivacaftor. With that being said, the progressive pulmonary decline and importance of lung health, infection, and inflammation in CF remains. This review is the second part in a three-part CF Year in Review 2020. Part one focused on the literature related to CFTR modulators while part three will feature the multisystem effects related to CF. This review focuses on articles from Pediatric Pulmonology, including articles from other journals that are of particular interest to clinicians. Herein, we highlight studies published during 2020 related to CF pulmonary disease, infection, treatment, and diagnostics.

Development of an Interdisciplinary Telehealth Care Model in a Pediatric Cystic Fibrosis Center

Background: People with cystic fibrosis (PCF) have unique physical and emotional needs, which are best met through interdisciplinary care (IDC). In the midst of the pandemic, our center aimed to begin a telehealth care model with an objective to increase successful care visits from baseline of 0-95% by June 26, 2020, including meeting cystic fibrosis (CF) care standards of IDC visits that are coproduced through agenda setting with PCF. Methods: Shifting IDC for pediatric CF patients to telehealth was part of a quality improvement initiative. Our team used asynchronous virtual visits (VVs), with the IDC team members' VVs done on different days than the physician's. Multiple plan-do-study-act cycles were completed to address evolving telehealth needs, including IDC team member flow logistics, communication with PCF, and surveying PCF for the patient perspective. Rates of IDC and agenda setting were measured from March 16, 2020 to June 26, 2020. Results: IDC VVs were at 86% in March 2020 with fluctuations until mid-May when we reached 100% and achieved sustainability. Agenda setting was reached at 100% and maintained. With continued effort, an additional 46.3% of PCF registered for the patient portal, totaling 90.6% with access. Our survey revealed 100% of PCF were able to see IDC team members that they needed to, with 87% "extremely satisfied" and 13% "somewhat satisfied" with their telehealth experience. Conclusions: Successful telehealth in pediatric CF IDC can be achieved through continuous communication, optimal utilization of available technologies, and may help foster unique opportunities to help improve health outcomes.