Improving Outcomes Through Quality Improvement

Abstract

The nutrition quality improvement (QI) program at the Cystic Fibrosis (CF) Center of Childrens Hospital Los Angeles (CHLA)aimed to increase patient body mass index (BMI) through improved clinician (physician, dietitian, and social worker) adherence to nutrition recommendations set forth by the Cystic Fibrosis Foundation (CFF). The QI program used a combination of strategies intended to increase cognitive cues for desired behaviors and to promote environmental change intended to prompt clinicians to adopt nutrition treatment recommendations. Program analysis involved collection of data on clinician behavior, nutrition treatment plans, and patient BMI. Evaluation involved a pretest—posttest design with multiple observations to determine behavior maintenance throughout the 18-month study period. Results indicate that the program produced changes in clinician behavior as evidenced by increased rates of adherence to nutrition recommendations, including the use of BMI/age as the primary nutrition marker and recommending aggressive nutrition treatment, though with noted attrition by the final data collection period. A clear trend toward improvement in BMI/age was evident with statistical significance at the P < .05 level. The QI program demonstrated that simple behavior cues in combination with training can produce changes in clinician behavior, which in turn affects patient outcomes.