title: Sustained improvement in nutritional outcomes at two paediatric cystic fibrosis centres after quality improvement collaboratives.
abstract: OBJECTIVE
  To describe the characteristics of sustained improved nutritional outcomes through the use of quality improvement (QI) methodology.
  
  
  METHODS
  Retrospective analysis of a QI intervention in two institutions, implemented as part of larger national collaboratives.
  
  
  METHODS
  Paediatric cystic fibrosis (CF) programmes in academic centres in Alabama and Illinois.
  
  
  METHODS
  All paediatric patients enrolled in the CF Foundation (CFF) Patient Data Registry were included.
  
  
  METHODS
  Improved and sustained nutrition outcomes occurred through implementation of the CFF practice guidelines for CF nutrition management via care delivery processes, nutritional interventions, team engagement and data display.
  
  
  METHODS
  Mean body mass index (BMI) percentile, percentage of patients less than 50th percentile and percentage less than 10th percentile for all patients aged 2-20 years were tracked through run charts and statistical process control charts. Mann-Whitney U and χ(2) tests were used to determine significance between each centre and national outcomes.
  
  
  RESULTS
  Each centre achieved rapid improvement in mean BMI percentile in patients, one centre rising from the 40th percentile in 2001 to the 49th percentile in 2003, the other rising from the 37th percentile in 2003 to the 45th percentile in 2004. These centres have also maintained improved nutritional outcomes, so that they were at the 60th and 55th percentiles, respectively, in 2011. Sustained improvement was accomplished through QI methodology, use of data as a driver for improvement and a change in culture.
  
  
  CONCLUSIONS
  Participation in collaboratives led to improved nutrition outcomes while a strong culture of QI facilitated sustained improvement.
authors.affiliation: Department of Pediatrics, Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, , Chicago, Illinois, USA.
authors.forename: Adrienne P
authors.initials: AP
authors.lastname: Savant
authors.forename: LaCrecia J
authors.initials: LJ
authors.lastname: Britton
authors.forename: Kristofer
authors.initials: K
authors.lastname: Petren
authors.forename: Susanna A
authors.initials: SA
authors.lastname: McColley
authors.forename: Hector H
authors.initials: HH
authors.lastname: Gutierrez
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000407:Alabama; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D007087:Illinois; D008297:Male; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D009752:Nutritional Status / Q000502:physiology*; D005791:Patient Care / Q000379:methods; D058996:Quality Improvement; D011787:Quality of Health Care; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
keywords: Collaborative, Breakthrough Groups; Healthcare Quality Improvement; Paediatrics; Quality Improvement Methodologies