The impact of transforming healthcare delivery on cystic fibrosis outcomes: a decade of quality improvement at Cincinnati Children’s Hospital

• Published in: BMJ quality & safety Vol. 23; no. Suppl 1; pp. i56 - i63
• Main Authors: Siracusa, Christopher M, Weiland, Jeanne L, Acton, James D, Chima, Amitra K, Chini, Barbara A, Hoberman, Andrea J, Wetzel, J Denise, Amin, Raouf S, McPhail, Gary L
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2014
• Subjects: Adolescent; Child; Children & youth; Cystic fibrosis; Cystic Fibrosis - physiopathology; Cystic Fibrosis - therapy; Delivery of Health Care - organization & administration; Families & family life; Female; Health administration; Health care; Health Care Surveys; Hospitals; Hospitals, Pediatric; Humans; Leadership; Male; Medical screening; Ohio; Patient Care - methods; Patient Care Team - organization & administration; Program Evaluation; Quality Assurance, Health Care; Quality Improvement; Time Factors; Young Adult; Ohio; Patient-Centred Care; Quality Improvement; Paediatrics; Chronic Disease Management
• ISSN: 2044-5415; 2044-5423
• DOI: 10.1136/bmjqs-2013-002361

Background In 2001, Cincinnati Children's Hospital embarked on a journey to improve healthcare delivery to patients with cystic fibrosis (CF). Data from the Cystic Fibrosis Foundation National Patient Registry revealed our below-average clinical outcomes, prompting us to initiate improvement interventions. Objective To improve clinical outcomes for patients with CF through a comprehensive quality-improvement approach directed at increasing patient centredness and improving healthcare delivery. Interventions In 2001, we shared our below-average outcomes with patients, families and care providers. We instituted a quality-improvement steering committee with parental and hospital leadership, and our data-management support was restructured to provide real-time clinical data to monitor our progress. In 2002, our weekly chart conference changed to a prospective planning session and individualised daily schedules were created for inpatients. In 2003, an influenza vaccination campaign was initiated and our infection-control practices were redesigned. In 2005, best-practice guidelines were developed for airway-clearance therapy. In 2007, evidence-based clinical algorithms were designed and implemented and key care-team members were added. Measurements Primary outcome measures were median forced expiratory volume in 1 s per cent predicted (age range 6–17 years) and median body mass index percentile (age range 2–20 years). Results From 2000 to 2010, median forced expiratory volume in 1 s increased from 81.7% to 100.1% predicted and median body mass index increased from the 35th to the 55th centile. Discussion By focusing on specific outcomes, empowering families and patients, effectively using data, and standardising care processes, we transformed the culture and delivery of care for our patients with CF and learned valuable lessons potentially translatable to other chronic-care providers.