title: Increasing Efficiency in Evaluation of Chronic Cough: A Multidisciplinary, Collaborative Approach.
abstract: Chronic cough is the most common reason for medical office visits in the United States. The typical patient has coughed more than 8 years and seen many specialists. This quality improvement project is an ambulatory clinic redesign to deliver efficient, patient-centered care with interspecialty collaboration. Methodology included the Institute for Healthcare Improvement collaborative model focused on Lean/Six Sigma and ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) Change Management. Interventions targeted education to referring providers, implementation of software changes, building a collaborative interdepartmental scheduling decision tree, and an interclinic dashboard enhancing communication and decision support. Outcome measures compare group resource utilization, evidenced by the total number of specialist referrals for same indication of chronic cough (International Classification of Diseases, Ninth Revision: 786.2), and length of time to complete evaluation. A retrospective review of 165 medical records yielded 2 groups, "current care" (n = 67) and "intervention" (n = 68). The number of specialist referrals per patient was reduced in the intervention group (M = 1.22, SD = 0.48) compared with the current care group (M = 3.33, SD = 1.02). Length of itinerary was reduced in the intervention group (M = 11.90, SD = 12.13, GM = 6.82) compared with the current care group (M = 126.93, SD = 158.13, GM = 54.8). Multidisciplinary collaboration, communication, coordinating diagnosis, and management of multifactorial conditions, such as chronic cough, are associated with lower costs and decreased utilization of health care resources.
authors.affiliation: Division of Pulmonary and Critical Care Medicine (Drs Patton and Lim) and Department of Systems and Procedures (Mr Ramlow), Mayo Clinic, Rochester, Minnesota; and the Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland (Dr White).
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Patton
authors.forename: Kaiser G
authors.initials: KG
authors.lastname: Lim
authors.forename: Luke W
authors.initials: LW
authors.lastname: Ramlow
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: White
mesh_terms: D002908:Chronic Disease; D003299:Cooperative Behavior; D003371:Cough / Q000175:diagnosis / Q000628:therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care; D012189:Retrospective Studies