(99) Improving Screening for Cystic Fibrosis-Related Diabetes in a Pediatric Cystic Fibrosis Clinic

Background: Cystic fibrosis related diabetes (CFRD) is the most common comorbidity in people with cystic fibrosis (CF) and affects ~20% of adolescents and 40-50% of adults [1]. CF care guidelines recommend screening for CFRD using the 75-gram 2-hour oral glucose tolerance test (OGTT) yearly beginning at 10 years old. Our CF center had below-average percentage of eligible patients adequately screened for CFRD [65% total screened (but only 36% with recommended OGTT) vs ~63% nationally] due to use of a non-preferred screening method and wide clinic catchment area. We initiated a QI project to improve our percentage of eligible CF patients appropriately screened per recommended CF care guidelines.

Methods: We began in 2019 by reviewing our current data and processes to understand our baseline, goals and anticipated barriers. We then established the goals of our project with proposed interventions and obtained institutional IRB approval. The three goals of our project were to 1) fully eliminate use of the non-preferred screening method by then end of 2020, 2) streamline local OGTT location options for families that live far from our CF center and 3) improve the percentage of eligible patients screened via OGTT by 20% by the end of 2020. We accomplished these goals by educating families regarding the recommended CFRD screening by OGTT in our CF newsletter, surveying families on how, when and where they would like to complete their OGTT testing, and by creating an OGTT informational brochure including three selected locations across our clinic geographical coverage area where OGTTs can be reliably obtained. An additional goal was added in January 2022 as we noted our percentage of appropriately screened patients dropped in 2021. We aimed to increase our percentage of eligible patients screened by 10% for the year. We are doing this by changing the location of an outlying OGTT facility after receiving negative feedback from our patients.

Results: We fully eliminated use of the non-preferred screening method by 2020; all patients screened in 2020 were done by OGTT. We increased our total screening percentage from 65% in 2019 to 86% percent in 2020, despite difficulties created by the COVID pandemic. Our screening percentage dropped to 78% in 2021 but we have worked to offer OGTT at one of our associated pediatric clinic locations to better serve families.

Conclusions: Using traditional QI methods and processes, we successfully eliminated use of a non-preferred CFRD screening method in our pediatric CF clinic. We have successfully increased our screening rates to above the national average and continue to work on improving the CFRD screening process for our patients and families.

Acknowledgements:

References: < [1]Moran A, Dunitz J, Nathan B, Saeed A, Holme B, Thomas W. Cystic fibrosis-related diabetes: current trends in prevalence, incidence and mortality. Diabetes Care 2009; 32:1626-1631.