title: Improving performance in the detection and management of cystic fibrosis-related diabetes in the Mountain West Cystic Fibrosis Consortium.
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).
  
  
  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 z-score (-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.
authors.affiliation: University of Utah , Salt Lake City, Utah , USA.
authors.forename: Theodore G
authors.initials: TG
authors.lastname: Liou
authors.affiliation: University of Utah , Salt Lake City, Utah , USA.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Jensen
authors.affiliation: University of New Mexico , Albuquerque, New Mexico , USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Allen
authors.affiliation: National Jewish Health , Denver, Colorado , USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Brayshaw
authors.affiliation: University of Arizona , Tucson, Arizona , USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Brown
authors.affiliation: University of Utah , Salt Lake City, Utah , USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Chatfield
authors.affiliation: National Jewish Health, Denver, Colorado, USA; Colorado Department of Public Health and Environment, Denver, Colorado, USA.
authors.forename: Joni
authors.initials: J
authors.lastname: Koenig
authors.affiliation: University of Utah , Salt Lake City, Utah , USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: McDonald
authors.affiliation: University of Utah , Salt Lake City, Utah , USA.
authors.forename: Kristyn A
authors.initials: KA
authors.lastname: Packer
authors.affiliation: Phoenix Children's Hospital , Phoenix, Arizona , USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Peet
authors.affiliation: Phoenix Children's Hospital , Phoenix, Arizona , USA.
authors.forename: Peggy
authors.initials: P
authors.lastname: Radford
authors.affiliation: University of New Mexico , Albuquerque, New Mexico , USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Reineke
authors.affiliation: University of Arizona, Tucson, Arizona, USA; Loma Linda University, Loma Linda, California, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Children's Hospital Colorado, Aurora, Colorado, USA; University of Colorado, Aurora, Colorado, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Wagener
authors.affiliation: University of Utah , Salt Lake City, Utah , USA.
authors.forename: David
authors.initials: D
authors.lastname: Young
authors.affiliation: University of Utah, Salt Lake City, Utah, USA; Cystic Fibrosis Foundation, Bethesda, Maryland, USA.
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Marshall
keywords: Cystic Fibrosis; Guideline Adherence; Quality Improvement; Weight