title: Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting.
abstract: BACKGROUND
  The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of patients who achieved resolution of CMT within 6 months of evaluation.
  
  
  OBJECTIVE
  The aims of this report are to describe the QI activities conducted to improve patient outcomes and discuss the results and implications for other institutions and patient populations.
  
  
  METHODS
  This was a quality improvement study.
  
  
  METHODS
  In alignment with the Chronic Care Model and Model of Improvement, an aim and operationally defined key outcome and process measures were established. Interventions were tested using Plan-Do-Study-Act cycles. A CMT registry was established to store and manage data extracted from the electronic record over the course of testing. Statistical process control charts were used to monitor progress over time.
  
  
  RESULTS
  The QI initiative resulted in an increase in the percentage of patients who achieved full resolution of CMT within a 6-month episode of care from 42% to 61% over an 18-month period. Themes that emerged as key drivers of improvement included: (1) timely, optimal access to care, (2) effective audit and clinician feedback, and (3) accurate, timely documentation.
  
  
  CONCLUSIONS
  The initiative took place at a single institution with a supportive culture and strong QI resources, which may limit direct translation of interventions and findings to other institutions and patient populations.
  
  
  CONCLUSIONS
  Improvement science methodologies provided the tools and structure to improve division-wide workflow and increase consistency in the implementation of the APTA CMT guideline. In doing so, significant CMT population outcome improvements were achieved.
authors.affiliation: Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, 3430 Burnet Ave, Cincinnati, OH 45229 (USA).
authors.forename: Mariann L
authors.initials: ML
authors.lastname: Strenk
authors.affiliation: Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center.
authors.forename: Michelle
authors.initials: M
authors.lastname: Kiger
authors.affiliation: James M. Anderson Center for Clinical Systems Excellence, Cincinnati Children's Hospital Medical Center.
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Hawke
authors.affiliation: Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center.
authors.forename: Amy
authors.initials: A
authors.lastname: Mischnick
authors.affiliation: Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, and Division of Sports Medicine, Cincinnati Children's Hospital Medical Center.
authors.forename: Catherine
authors.initials: C
authors.lastname: Quatman-Yates
mesh_terms: D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012042:Registries; D014103:Torticollis / Q000151:congenital* / Q000534:rehabilitation; D016896:Treatment Outcome