Impact of a program ensuring consistent response to acute drops in lung function in children with cystic fibrosis
Impact of a program ensuring consistent response to acute drops in lung function in children with cystic fibrosis
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DOI：
10.1016/j.jcf.2018.06.003
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发表时间：
2018-11-01
影响因子：
5.2
通讯作者：
Molzhon, Andrea
中科院分区：
文献类型：
--
作者：
Schechter, Michael S.;Schmidt, H. Joel;Molzhon, Andrea
背景：CF 肺部结果的变化是多因素的，但一个重要因素似乎取决于 CF 中心护理的差异。先前的研究表明，高性能的囊性纤维化中心在治疗肺部病情加重方面更加一致和积极主动。我们将这种方法纳入一个可以与其他 CF 中心捆绑和共享的计划中。 方法：里士满儿童医院 CF 肺部护理的重组包括开发肺部算法来定义对肺功能变化的标准反应，并运行图表来跟踪过程和结果测量。我们计算了过去 12 个月的最佳预测 FEV1 百分比 (ppFEV1) 的滚动平均值，作为我们的主要结果指标。结果：过去 12 个月的最佳 ppFEV1 平均值从 2013 年 1 月的 87% 预测值（13-18 岁预测值 65%，6-13 岁预测值 97%）上升到 2013 年 1 月预测值的 98%（13-18 岁预测值 95%， 2018 年 1 月，6-13 岁儿童的预测为 110%。在此期间，6-13 岁儿童和 13-18 岁青少年之间的 ppFEV1 差异从 34 下降到 14。结论：使用基本的质量改进原则可以快速实现肺部结局的改善，包括跨学科团队目标设定、确保一致识别和治疗肺部病情加重的标准化和主动方法，以及使用数据来跟踪过程的有效性。我们相信所涉及的步骤对于其他 CF 中心来说很容易适应自己的设置。 (C) 2018 年欧洲囊性纤维化协会。由 Elsevier B.V. 出版。保留所有权利。
Background: Variation in CF pulmonary outcomes is multifactorial, but a significant component appears to be dependent upon differences in CF Center care. Previous investigations suggest that high performing CF centers are more consistent and proactive in the treatment of pulmonary exacerbations. We incorporated this approach into a program that could be bundled and shared with other CF Centers.Methods: The reorganization of CF pulmonary care at the Children's Hospital of Richmond included the development of a pulmonary algorithm to define a standard response to changes in lung function and run charts to track process and outcome measures. We calculated the rolling average of the best percent predicted FEV1 (ppFEV1) over the previous 12 months as our primary outcome measure.Results: The mean of the best ppFEV1 in the previous 12 months rose from 87% predicted (65% predicted for those 13-18 years, 97% predicted for those 6-13 years) in January 2013 to 98% predicted (95% predicted for those 13-18 years, 110% predicted for those 6-13 years) in January 2018. The ppFEV1 difference between children 6-13 years and adolescents 13-18 years dropped from 34 to 14 during that time.Conclusions: Improvements in pulmonary outcomes can be accomplished rapidly using basic quality improvement principles, including interdisciplinary team goal setting, standardized and proactive approaches that ensure consistent recognition and treatment of pulmonary exacerbations, and the use of data to follow the effectiveness of the process. We believe that the steps involved would be easy for other CF Centers to adapt to their own settings. (C) 2018 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.