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Marpole RM, Schultz A, Wilson AC. Improving screening in a paediatric cohort for cystic fibrosis-related diabetes: A quality improvement project. Pediatr Pulmonol 2024. [PMID: 38990108 DOI: 10.1002/ppul.27173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/05/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Rachael M Marpole
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Division of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - André Schultz
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Andrew C Wilson
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Division of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
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Chokkalla AK, Tuley P, Kurtca M, Ona H, Ruiz FE, Devaraj S. Cystic fibrosis-related diabetes screening at a large pediatric center. Lab Med 2024:lmae009. [PMID: 38387038 DOI: 10.1093/labmed/lmae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE Cystic Fibrosis Foundation guidelines recommend annual diabetes screening by oral glucose tolerance test (OGTT) in pediatric patients with cystic fibrosis (CF) starting at the age of 10 years. Adherence to these guidelines proves to be challenging, and the nationwide screening rates are still considered suboptimal. The aim of this study was to assess and improve the screening rates at our large pediatric center. METHODS A 4-year retrospective audit of OGTT completion among pediatric patients with CF of age ≥10 years who are not yet diagnosed with diabetes was conducted. A collaborative working group was formed to identify the barriers to screening and formulate a quality improvement plan, which was monitored and evaluated for a 9-month period. RESULTS Diabetes screening rates determined by OGTT completion at our center showed a gradual decline during the COVID-19 pandemic from 2019 to 2022. Following the implementation of the quality improvement plan during the summer of 2023, there was a marked increase in OGTT ordering compliance by providers as well as test completion by patients. Notably, the fractional OGTT completion rate rose from 45% during the preintervention phase (January-April 2023) to 70% during the postintervention phase (May-September 2023). CONCLUSION Diabetes screening in pediatric patients with CF can be effectively improved by refining practices related to patient experience, care coordination, and laboratory testing strategies.
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Affiliation(s)
- Anil K Chokkalla
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, US
- Department of Pathology, Texas Children's Hospital, Houston, TX, US
| | - Pamela Tuley
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, US
| | - Miray Kurtca
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, US
- Department of Pathology, Texas Children's Hospital, Houston, TX, US
| | - Herda Ona
- Department of Pathology, Texas Children's Hospital, Houston, TX, US
| | - Fadel E Ruiz
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, US
| | - Sridevi Devaraj
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, US
- Department of Pathology, Texas Children's Hospital, Houston, TX, US
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Weeks C, Jackson S, Demirel N, Olson J, Dean V, Pyrz C, Creo AL. Oral Glucose Tolerance Testing Using Candy: A Sweet Solution to Improve Screening in Children with Cystic Fibrosis? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1317. [PMID: 37628316 PMCID: PMC10453265 DOI: 10.3390/children10081317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Oral glucose tolerance testing is recommended for all children with CF older than 9 years, yet compliance remains poor across centers. METHODS We performed a small pilot study assessing the glycemic curves and participant satisfaction in seven children and adolescents. RESULTS We chose a dextrose-based candy (Nerds®) free of any fat, fiber, gelatin, or corn syrup and performed the candy OGTT 1-4 days following the standard oral dextrose solution OGTT. Glucose values at 120 min were similar between the candy and oral dextrose solution (p = 0.8986). CONCLUSIONS Our small pilot suggests that a carefully selected candy alternative may result in similar glycemic OGTT when compared to the standard oral dextrose solution. However, some participants preferred the oral dextrose solution to candy due to having to consume a large volume in a short period of time. This may have significant implications as centers consider candy alternatives to increase OGTT adherence rates.
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Affiliation(s)
- Caroline Weeks
- Mayo Clinic Pediatric Endocrinology Cystic Fibrosis Center, Mayo Clinic, Rochester, MN 55905, USA; (C.W.)
| | - Sarah Jackson
- Division of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Nadir Demirel
- Mayo Clinic Pediatric Endocrinology Cystic Fibrosis Center, Mayo Clinic, Rochester, MN 55905, USA; (C.W.)
- Division of Pediatric Pulmonology, Rochester, MN 55905, USA
| | - Janelle Olson
- Mayo Clinic Pediatric Endocrinology Cystic Fibrosis Center, Mayo Clinic, Rochester, MN 55905, USA; (C.W.)
- Division of Pediatric Pulmonology, Rochester, MN 55905, USA
| | - Vicki Dean
- Mayo Clinic Pediatric Endocrinology Cystic Fibrosis Center, Mayo Clinic, Rochester, MN 55905, USA; (C.W.)
- Division of Pediatric Pulmonology, Rochester, MN 55905, USA
| | - Caitlin Pyrz
- Mayo Clinic Pediatric Endocrinology Cystic Fibrosis Center, Mayo Clinic, Rochester, MN 55905, USA; (C.W.)
- Division of Pediatric Pulmonology, Rochester, MN 55905, USA
| | - Ana L. Creo
- Mayo Clinic Pediatric Endocrinology Cystic Fibrosis Center, Mayo Clinic, Rochester, MN 55905, USA; (C.W.)
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Khare S, Desimone M, Kasim N, Chan CL. Cystic fibrosis-related diabetes: Prevalence, screening, and diagnosis. J Clin Transl Endocrinol 2022; 27:100290. [PMID: 34917485 PMCID: PMC8669384 DOI: 10.1016/j.jcte.2021.100290] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Abstract
Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in patients with cystic fibrosis (CF). Prevalence of CFRD increases with age and is greater with severe mutations. Other risk factors associated with CFRD are female sex, pancreatic insufficiency, liver disease, need for gastrostomy tube feedings, history of bronchopulmonary aspergillosis, and poor pulmonary function. CFRD is related to worse clinical outcomes and increased mortality. Early diagnosis and treatment have been shown to improve clinical outcomes. Screening for CFRD is recommended with an annual oral glucose tolerance test (OGTT) starting at age 10 years. Diagnosis of CFRD is made by standard American Diabetes Association (ADA) criteria during baseline health. CFRD can also be diagnosed in individuals with CF during acute illness, while on enteral feeds, and after transplant. In this review we will discuss the epidemiology of CFRD and provide an overview of the advantages and pitfalls of current screening and diagnostic tests for CFRD.
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Affiliation(s)
- Swapnil Khare
- Division of Endocrinology, Diabetes and Metabolism, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Marisa Desimone
- Division of Endocrinology, Diabetes and Metabolism SUNY, Upstate Medical University, Syracuse, NY, United States
| | - Nader Kasim
- Division of Pediatric Endocrinology, Michigan State University, Helen Devos Children's Hospital/Spectrum Health, Grand Rapids, MI, United States
| | - Christine L. Chan
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Bonhoure A, Potter KJ, Colomba J, Boudreau V, Bergeron C, Desjardins K, Carricart M, Tremblay F, Lavoie A, Rabasa-Lhoret R. Peak glucose during an oral glucose tolerance test is associated with future diabetes risk in adults with cystic fibrosis. Diabetologia 2021; 64:1332-1341. [PMID: 33693987 DOI: 10.1007/s00125-021-05423-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/11/2021] [Indexed: 01/06/2023]
Abstract
AIMS/HYPOTHESIS Cystic fibrosis-related diabetes (CFRD) affects up to 50% of adults with cystic fibrosis (CF) and its presence is associated with adverse effects on nutritional status and pulmonary function. Early diagnosis could minimise CFRD morbidity, yet current methods of an OGTT at 0 and 2 h yield unreliable results. Our aim was to determine which indices from a 2 h OGTT with sampling every 30 min might improve prediction of CFRD. METHODS Cross-sectional analysis at baseline (n = 293) and observational prospective analysis (n = 185; mean follow-up of 7.5 ± 4.2 years) of the Montreal Cystic Fibrosis Cohort were performed. Blood glucose and insulinaemia OGTT variables were studied in relation to lung function (forced expiratory volume in 1 s [FEV1]), BMI and risk of developing CFRD. RESULTS At baseline, maximum OGTT glucose (Gmax) was negatively associated with FEV1 (p = 0.003). Other OGTT values, including classical 2 h glucose, were not. A higher Gmax was associated with lower insulin secretory capacity, delayed insulin peak timing and greater pancreatic insufficiency (p < 0.01). Gmax was positively associated with the risk of developing CFRD (p = 0.0029); no individual with a Gmax < 8 mmol/l developed CFRD over the following decade. No OGTT variable correlated to the rate of change in BMI or FEV1. CONCLUSIONS/INTERPRETATION In adults with CF, Gmax is strongly associated with the risk of developing CFRD; Gmax < 8 mmol/l could identify those at very low risk of future CFRD. Gmax is higher in individuals with pancreatic insufficiency and is associated with poorer insulin secretory capacity and pulmonary function.
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Affiliation(s)
- Anne Bonhoure
- Montreal Clinical Research Institute, Montreal, QC, Canada
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Johann Colomba
- Montreal Clinical Research Institute, Montreal, QC, Canada
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Valérie Boudreau
- Montreal Clinical Research Institute, Montreal, QC, Canada
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Cindy Bergeron
- Montreal Clinical Research Institute, Montreal, QC, Canada
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Maïté Carricart
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Cystic Fibrosis Clinic, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - François Tremblay
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Cystic Fibrosis Clinic, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - Annick Lavoie
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Cystic Fibrosis Clinic, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, Montreal, QC, Canada.
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
- Cystic Fibrosis Clinic, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada.
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Glycated Hemoglobin as a First-line Screening Test for Cystic Fibrosis‒Related Diabetes and Impaired Glucose Tolerance in Children With Cystic Fibrosis: A Validation Study. Can J Diabetes 2021; 45:768-774. [PMID: 33926819 DOI: 10.1016/j.jcjd.2021.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/26/2021] [Accepted: 03/22/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Our aims in this study were to document the screening rate for cystic fibrosis‒related diabetes (CFRD) in children followed at a cystic fibrosis (CF) clinic in Canada and to evaluate the accuracy of various glycated hemoglobin (A1C) cutoffs to screen for CFRD and impaired glucose tolerance (IGT) in a pediatric CF population. METHODS The CFRD screening rate was calculated over a follow-up period of up to 8 years among children who attended the CF clinic between 1993 and 2018. Test performance of A1C at various thresholds ranging from 5.5% to 6.2% was compared with the oral glucose tolerance test (OGTT) as the reference method. Children with CF aged ≥10 years with an OGTT performed within 120 days of A1C measurement were included in the analysis. RESULTS The overall CFRD screening rate was 53.0%. A total of 256 children were included for the A1C performance analysis, of whom 8.6% had an OGTT-confirmed CFRD diagnosis. An A1C threshold of 5.8% demonstrated an optimal balance between sensitivity (90.9%) and specificity (60.7%) for CFRD screening, leading to a potential reduction of 56.3% of the annual required OGTTs. A1C demonstrated poor accuracy for identifying children with IGT. CONCLUSIONS An A1C threshold ≥5.8% allows for identification of children requiring further CFRD investigations, which may reduce the clinical burden of children with CF without compromising the ability of early CFRD diagnosis.
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Driscoll KA, Tamura R, Johnson SB, Gesualdo P, Clasen J, Smith L, Jacobsen L, Larsson HE, Haller MJ. Adherence to oral glucose tolerance testing in children in stage 1 of type 1 diabetes: The TEDDY study. Pediatr Diabetes 2021; 22:360-368. [PMID: 33179853 PMCID: PMC7913602 DOI: 10.1111/pedi.13149] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To examine adherence to the oral glucose tolerance test (OGTT) in multiple islet autoantibody children in stage 1 of developing type 1 diabetes (T1D). METHODS Children are followed from birth in The Environmental Determinants of Diabetes in the Young (TEDDY) study. Completion of an OGTT is recommended every 6 months in children ≥3 years of age who are multiple islet autoantibody positive. Factors associated with adherence to the OGTT protocol were examined. RESULTS The average subject level adherence with the OGTT protocol was 62% although there were large differences across countries; Finnish participants and older children from Sweden were more adherent than participants from the United States and Germany. Factors associated with nonadherence included having a first-degree relative with T1D, using a local laboratory rather than a TEDDY center for the OGTT, and maternal underestimation of the child's risk for T1D. Children were more adherent to the OGTT if their mothers: were more satisfied with TEDDY participation, reported monitoring the child for T1D by checking blood glucose levels at home, and viewed participating in TEDDY as the primary way they were monitoring the child for T1D. CONCLUSIONS In a study of children in stage 1 of T1D, adherence to an OGTT protocol was suboptimal despite extensive efforts to communicate the child's high risk to parents. These findings provide important guidance for development of strategies to improve methods for detecting progression or the development of T1D in high-risk pediatric populations.
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Affiliation(s)
- Kimberly A. Driscoll
- College of Public Health & Health Professions, Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Roy Tamura
- Health Informatics Institute, University of South Florida, Tampa, Florida, USA
| | | | - Patricia Gesualdo
- School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joanna Clasen
- Health Informatics Institute, University of South Florida, Tampa, Florida, USA
| | - Laura Smith
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laura Jacobsen
- College of Medicine, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Helena Elding Larsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatrics, Skane University Hospital, Malmo, Sweden
| | - Michael J. Haller
- College of Medicine, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
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Boudreau V, Reynaud Q, Bonhoure A, Durieu I, Rabasa-Lhoret R. Validation of a Stepwise Approach Using Glycated Hemoglobin Levels to Reduce the Number of Required Oral Glucose Tolerance Tests to Screen for Cystic Fibrosis–Related Diabetes in Adults. Can J Diabetes 2019; 43:161-162. [DOI: 10.1016/j.jcjd.2018.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 11/24/2022]
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Bazemore KE, Barker M, Morgan BT, Goode V. Utilization of the STOP-Bang Questionnaire as a Standardized Screening Tool for Obstructive Sleep Apnea in Veteran Administration Surgical Patients. J Perianesth Nurs 2018; 34:60-65. [PMID: 29685727 DOI: 10.1016/j.jopan.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) affects an estimated 20% of the adult surgical population. Veteran patients have many characteristics consistent with OSA, but lack of standardized screening results in decreased detection of patients at risk for OSA. DESIGN Pre-post implementation design. METHODS Preanesthesia clinic providers were educated about OSA and the STOP-Bang questionnaire. Chart reviews evaluating screening and patient demographics were conducted before and after intervention. FINDINGS Thirty-one percent of patients had an established diagnosis of OSA. Compliance rates with preoperative STOP-Bang screening were 91.3%. Of patients screened preoperatively, 44% were at risk for OSA with a STOP-Bang score of 4 or greater. CONCLUSIONS The prevalence of patients among the Veteran population with and at risk for OSA is higher than the general population. Utilization of the STOP-Bang questionnaire as a standardized preoperative screening tool in preanesthesia clinics can increase the identification of patients at risk for OSA.
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Sabadosa KA, Godfrey MM, Marshall BC. Trans-Atlantic collaboration: applying lessons learned from the US CF Foundation quality improvement initiative. Orphanet J Rare Dis 2018; 13:13. [PMID: 29799379 PMCID: PMC6225611 DOI: 10.1186/s13023-017-0744-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Between 2002 and 2006 France launched a national cystic fibrois (CF) newborn screening program; organized a network of specialized CF care centers; and issued CF diagnostic and treatment standards. To continue to build on this success in 2007 the Cystic Fibrosis Center of Expertise for Rare Diseases (CF CERD) of Nantes-Roscoff in partnership with the French CF Society, the French CF Association (Vaincre la Mucoviscidose), and all CF center leaders from across the country agreed to pursue center-level improvement in medical outcomes for people with CF by adapting the U.S. Cystic Fibrosis Foundation’s (US CFF) national initiative, Accelerating the Rate of Improvement in CF Care. To launch the Program to Improve Results and Expertise in CF (le Programme d’Amélioration des Résultats et de l’Expertise en Mucoviscidose - PHARE-M), French leaders pursued mentorship and guidance from leaders at the US CFF, the Dartmouth Institute (TDI), and clinical care teams at CF centers across the U.S. Methods The following activities enabled the Nantes-Roscoff CF CERD team members and a parent, involved with the French CF Association board and a quality engineer by training, to gain the leadership and quality improvement knowledge and skills necessary to implement the PHARE-M program: 1) regularly attending national meetings, tracking publications, and leveraging existing partnerships; 2) completing two sabbaticals to visit U.S. CF centers and enrolling in academic and professional training courses; and, 3) inviting US CFF and TDI leaders to France to meet key opinion leaders and frontline teams. Conclusions The Nantes-Roscoff CF CERD team successfully adapted the US CFF’s initiative to accelerate improvement in CF care by establishing a partnership with U.S. leaders to communicate and exchange strategies and lessons learned; intentionally studying and adapting the Clinical Microsystems approach to quality improvement; and learning directly from the experience of frontline teams in the U.S. They continue to partner with U.S. leaders and are seeking to collaborate with European colleagues to continue to improve care for individuals with CF and their families across Europe.
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Affiliation(s)
- Kathryn A Sabadosa
- The Dartmouth Institute for Health Policy & Clinical Practice, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Marjorie M Godfrey
- The Dartmouth Institute for Health Policy & Clinical Practice, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Bruce C Marshall
- Cystic Fibrosis Foundation, 4550 Montgomery Ave. Suite 1100 N, Bethesda, MD, 20814, USA
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Abstract
Purpose
– Annual screening for cystic fibrosis-related-diabetes (CFRD) using oral glucose tolerance test (OGTT) is recommended, but national testing rates are low. The purpose of this paper is to implement the quality improvement (QI) initiative to improve cystic fibrosis (CF) annual screening rates among patients at one CF center.
Design/methodology/approach
– To improve screening for CFRD at the CF Center, the authors used the Dartmouth Microsystem Improvement Ramp method and formed a collaborative working group. A process map was created to outline the steps and a fishbone analysis was performed to identify barriers and to utilize resources for implementing new interventions.
Findings
– Prior to these interventions, 21 percent of eligible patients had completed annual screening and after the intervention, it rose to 72 percent. The initial completion rate with the first prescription was only 50 percent, but it improved steadily to 54/75 (72 percent) in response to reminder letters sent six weeks after the initial script was given.
Practical implications
– Close tracking and reminder letters can improve adherence with annual OGTT screening for CFRD among CF patients, with special emphasis on high-risk patients.
Originality/value
– There should be a special emphasis on screening for CFRD in high-risk CF patients (those with low BMI or higher age). This QI initiative brought about several operational changes in the annual OGTT screening process that have now become the standard operating procedure at the center.
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