title: Improvements in Cystic Fibrosis Quarterly Visits, Lung Function Tests, and Respiratory Cultures.
abstract: BACKGROUND
  The Cystic Fibrosis (CF) Foundation recommends patients attend clinic ≥4 times per year with 4 respiratory cultures and 2 pulmonary function tests (PFTs). However, nationally only 57.4% of patients met these guidelines in 2012. We used a quality improvement program with a goal of 75% of our patients meeting this care guideline by 2012.
  
  
  METHODS
  A 2-stage program was started in 2011. Stage 1: education of patients/caregivers on importance of quarterly visits. Stage 2: quarterly tracking system of patient appointments. Data on clinic visits, respiratory cultures, and PFTs were collected from the CF registry from January 2009 through December 2013. Statistical process control charts were used to track improvements.
  
  
  RESULTS
  The average number of clinic visits increased significantly from 4.6 ± 2.3 in 2009 to 6.3 ± 4.6 in 2013 (P < .0001). The percentage of patients ages 6 through 18 completing a clinic visit, PFT, and respiratory culture per quarter increased significantly from 76.2% during 2009 to 86.4% in 2013. The percentage of patients completing ≥4 clinic visits with 4 respiratory cultures and 2 PFTs improved significantly from 47.5% in 2009 to 71.0% in 2013 (P < .0001).
  
  
  CONCLUSIONS
  A tracking system of patient appointments significantly improved adherence to the care guidelines better than education alone. The multiple-stage quality improvement program we implemented may be modifiable and able to be integrated in other CF centers or other multiple disciplinary chronic illness care centers.
authors.affiliation: Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri; and jwooldr4@slu.edu.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Wooldridge
authors.affiliation: SSM Cardinal Glennon Children's Medical Center, St Louis, Missouri.
authors.forename: Susan
authors.initials: S
authors.lastname: Mason
authors.affiliation: SSM Cardinal Glennon Children's Medical Center, St Louis, Missouri.
authors.forename: Judith
authors.initials: J
authors.lastname: Brusatti
authors.affiliation: Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri; and.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Albers
authors.affiliation: Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri; and.
authors.forename: Blakeslee E
authors.initials: BE
authors.lastname: Noyes
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D012129:Respiratory Function Tests / Q000706:statistics & numerical data; D012137:Respiratory System / Q000382:microbiology