Improving performance in the detection and management of cystic fibrosisrelated diabetes in the Mountain west cystic fibrosis Consortium

Theodore G. Liou, Judith L. Jensen, Sarah E. Allen, Sara J. Brayshaw, Mark A Brown, Barbara Chatfield, Joni Koenig, Catherine McDonald, Kristyn A. Packer, Kimberly Peet, Peggy Radford, Linda M. Reineke, Kim Otsuka, Jeffrey S. Wagener, David Young, Bruce C. Marshall

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Cystic fibrosis (CF)-related diabetes (CFRD) is associated with increased morbidity and mortality. Improved detection and management may improve outcomes; however, actual practice falls short of published guidelines. We studied efforts to improve CFRD screening and management in the Mountain West CF Consortium (MWCFC). Research design and methods: This is a prospective observational cohort study evaluating quality improvement by accredited CF centers in Arizona, Colorado, New Mexico, and Utah performed between 2002 and 2008. After Institutional Review Board (IRB) approval, centers evaluated adherence with CF Foundation guidelines for CFRD. Each center developed and implemented quality improvement plans to improve both screening and management. Centers were reassessed 1 year later. Results: Initially, each CF center had low adherence with screening recommendations (26.5% of eligible patients) that did not improve during the study. However, patients with confirmed CFRD markedly increased (141 (12% of MWCFC patients) to 224 (17%), p<0.001), and with improved adherence to management guidelines, patients with CFRD had increased weight (56.8–58.9 kg, p<0.001), body mass index (21.1–21.4, p=0.003), and weight-for-age zscore (−1.42 to –0.84, p<0.001). Quality improvement methods were specific to the practice settings of each center but shared the common goal of adhering to CFRD care guidelines. 1 year after implementation, no center significantly differed from any other in level of adherence to guidelines. Conclusions: Improving adherence with CFRD care guidelines requires substantial effort and may be incompletely successful, particularly for CFRD screening, but the effort may significantly improve patient monitoring and clinically relevant outcomes such as weight.

Original languageEnglish (US)
Article numbere000183
JournalBMJ Open Diabetes Research and Care
Volume4
Issue number1
DOIs
StatePublished - Apr 29 2016

Fingerprint

Cystic Fibrosis
Guidelines
Quality Improvement
Weights and Measures
Guideline Adherence
Research Ethics Committees
Physiologic Monitoring
Observational Studies
Body Mass Index
Cohort Studies
Research Design
Morbidity
Mortality

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Improving performance in the detection and management of cystic fibrosisrelated diabetes in the Mountain west cystic fibrosis Consortium. / Liou, Theodore G.; Jensen, Judith L.; Allen, Sarah E.; Brayshaw, Sara J.; Brown, Mark A; Chatfield, Barbara; Koenig, Joni; McDonald, Catherine; Packer, Kristyn A.; Peet, Kimberly; Radford, Peggy; Reineke, Linda M.; Otsuka, Kim; Wagener, Jeffrey S.; Young, David; Marshall, Bruce C.

In: BMJ Open Diabetes Research and Care, Vol. 4, No. 1, e000183, 29.04.2016.

Research output: Contribution to journalArticle

Liou, TG, Jensen, JL, Allen, SE, Brayshaw, SJ, Brown, MA, Chatfield, B, Koenig, J, McDonald, C, Packer, KA, Peet, K, Radford, P, Reineke, LM, Otsuka, K, Wagener, JS, Young, D & Marshall, BC 2016, 'Improving performance in the detection and management of cystic fibrosisrelated diabetes in the Mountain west cystic fibrosis Consortium', BMJ Open Diabetes Research and Care, vol. 4, no. 1, e000183. https://doi.org/10.1136/bmjdrc-2015-000183
Liou, Theodore G. ; Jensen, Judith L. ; Allen, Sarah E. ; Brayshaw, Sara J. ; Brown, Mark A ; Chatfield, Barbara ; Koenig, Joni ; McDonald, Catherine ; Packer, Kristyn A. ; Peet, Kimberly ; Radford, Peggy ; Reineke, Linda M. ; Otsuka, Kim ; Wagener, Jeffrey S. ; Young, David ; Marshall, Bruce C. / Improving performance in the detection and management of cystic fibrosisrelated diabetes in the Mountain west cystic fibrosis Consortium. In: BMJ Open Diabetes Research and Care. 2016 ; Vol. 4, No. 1.
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abstract = "Objective: Cystic fibrosis (CF)-related diabetes (CFRD) is associated with increased morbidity and mortality. Improved detection and management may improve outcomes; however, actual practice falls short of published guidelines. We studied efforts to improve CFRD screening and management in the Mountain West CF Consortium (MWCFC). Research design and methods: This is a prospective observational cohort study evaluating quality improvement by accredited CF centers in Arizona, Colorado, New Mexico, and Utah performed between 2002 and 2008. After Institutional Review Board (IRB) approval, centers evaluated adherence with CF Foundation guidelines for CFRD. Each center developed and implemented quality improvement plans to improve both screening and management. Centers were reassessed 1 year later. Results: Initially, each CF center had low adherence with screening recommendations (26.5{\%} of eligible patients) that did not improve during the study. However, patients with confirmed CFRD markedly increased (141 (12{\%} of MWCFC patients) to 224 (17{\%}), p<0.001), and with improved adherence to management guidelines, patients with CFRD had increased weight (56.8–58.9 kg, p<0.001), body mass index (21.1–21.4, p=0.003), and weight-for-age zscore (−1.42 to –0.84, p<0.001). Quality improvement methods were specific to the practice settings of each center but shared the common goal of adhering to CFRD care guidelines. 1 year after implementation, no center significantly differed from any other in level of adherence to guidelines. Conclusions: Improving adherence with CFRD care guidelines requires substantial effort and may be incompletely successful, particularly for CFRD screening, but the effort may significantly improve patient monitoring and clinically relevant outcomes such as weight.",
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T1 - Improving performance in the detection and management of cystic fibrosisrelated diabetes in the Mountain west cystic fibrosis Consortium

AU - Liou, Theodore G.

AU - Jensen, Judith L.

AU - Allen, Sarah E.

AU - Brayshaw, Sara J.

AU - Brown, Mark A

AU - Chatfield, Barbara

AU - Koenig, Joni

AU - McDonald, Catherine

AU - Packer, Kristyn A.

AU - Peet, Kimberly

AU - Radford, Peggy

AU - Reineke, Linda M.

AU - Otsuka, Kim

AU - Wagener, Jeffrey S.

AU - Young, David

AU - Marshall, Bruce C.

PY - 2016/4/29

Y1 - 2016/4/29

N2 - Objective: Cystic fibrosis (CF)-related diabetes (CFRD) is associated with increased morbidity and mortality. Improved detection and management may improve outcomes; however, actual practice falls short of published guidelines. We studied efforts to improve CFRD screening and management in the Mountain West CF Consortium (MWCFC). Research design and methods: This is a prospective observational cohort study evaluating quality improvement by accredited CF centers in Arizona, Colorado, New Mexico, and Utah performed between 2002 and 2008. After Institutional Review Board (IRB) approval, centers evaluated adherence with CF Foundation guidelines for CFRD. Each center developed and implemented quality improvement plans to improve both screening and management. Centers were reassessed 1 year later. Results: Initially, each CF center had low adherence with screening recommendations (26.5% of eligible patients) that did not improve during the study. However, patients with confirmed CFRD markedly increased (141 (12% of MWCFC patients) to 224 (17%), p<0.001), and with improved adherence to management guidelines, patients with CFRD had increased weight (56.8–58.9 kg, p<0.001), body mass index (21.1–21.4, p=0.003), and weight-for-age zscore (−1.42 to –0.84, p<0.001). Quality improvement methods were specific to the practice settings of each center but shared the common goal of adhering to CFRD care guidelines. 1 year after implementation, no center significantly differed from any other in level of adherence to guidelines. Conclusions: Improving adherence with CFRD care guidelines requires substantial effort and may be incompletely successful, particularly for CFRD screening, but the effort may significantly improve patient monitoring and clinically relevant outcomes such as weight.

AB - Objective: Cystic fibrosis (CF)-related diabetes (CFRD) is associated with increased morbidity and mortality. Improved detection and management may improve outcomes; however, actual practice falls short of published guidelines. We studied efforts to improve CFRD screening and management in the Mountain West CF Consortium (MWCFC). Research design and methods: This is a prospective observational cohort study evaluating quality improvement by accredited CF centers in Arizona, Colorado, New Mexico, and Utah performed between 2002 and 2008. After Institutional Review Board (IRB) approval, centers evaluated adherence with CF Foundation guidelines for CFRD. Each center developed and implemented quality improvement plans to improve both screening and management. Centers were reassessed 1 year later. Results: Initially, each CF center had low adherence with screening recommendations (26.5% of eligible patients) that did not improve during the study. However, patients with confirmed CFRD markedly increased (141 (12% of MWCFC patients) to 224 (17%), p<0.001), and with improved adherence to management guidelines, patients with CFRD had increased weight (56.8–58.9 kg, p<0.001), body mass index (21.1–21.4, p=0.003), and weight-for-age zscore (−1.42 to –0.84, p<0.001). Quality improvement methods were specific to the practice settings of each center but shared the common goal of adhering to CFRD care guidelines. 1 year after implementation, no center significantly differed from any other in level of adherence to guidelines. Conclusions: Improving adherence with CFRD care guidelines requires substantial effort and may be incompletely successful, particularly for CFRD screening, but the effort may significantly improve patient monitoring and clinically relevant outcomes such as weight.

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