(97) Improving oral glucose tolerance testing rate through a cross-disciplinary quality improvement collaboration

Background: Annual oral glucose tolerance testing (OGTT) for people with CF (PwCF) who are 10 years of age and older is a key aspect of Cystic Fibrosis Foundation (CFF) care guidelines. Testing is critical to early detection of cystic fibrosis related diabetes, which impacts lung and nutritional health. The annual OGTT rate by CF Center is reported by CFF and contributes to health care institutional ranking by US News and World Report. From 2015 through 2019, the proportion screened at Seattle Children’s Hospital CF Clinic ranged from 55 – 69% and dropped to 49% in 2020. CF Center and hospital leadership identified annual OGTT for PwCF as an improvement opportunity.

Objective To perform an OGTT for >75% of eligible patients, including patients at least 10 years of age and not prescribed insulin between January 1 and December 31, 2021 with the goal of improving care by meeting CFF guidelines.

Methods: A cross-discipline quality improvement (QI) team convened with support from senior leaders who prioritized the project and responded to identified barriers. QI methods were applied with key driver diagram development and improvement framework implementation, hypothesizing that access to performance data and defining processes would lead to improvement. Interventions aimed toward tracking and scheduling, team engagement, patient and family engagement, and improving access to testing. The team reviewed monthly progress reports of testing to date from the CF Registry and a clinical database; reports were shared with clinic nurses and clinic providers. Scheduling barriers and PDSA cycles were discussed at huddles. Letters with testing instructions were sent to families; testing at a satellite clinic was implemented.

Results: QI team 30 minute huddles occurred every 2 weeks from April through December, 2021 with sustained team member attendance and facilitation by the division practice manager. A dashboard which pulled data from the electronic medical record (EMR) was used initially but abandoned due to complexity of the data acquisition. A reliable process was developed by team members to generate monthly data reports, imported to Excel, for timely review and sharing with the QI and clinic teams. Schedulers developed a process to review upcoming clinic appointments for PwCF requiring an OGTT with proactive advance scheduling. Clinic nurses collaborated with providers to order OGTTs at the quarterly clinic visit prior to the test date. Satellite clinic testing was initiated with scheduling for families on request. The rate of OGTT improved to 82% in eligible patients in 2021.

Conclusions: Motivations for improving OGTT rates in PwCF are multifaceted with the aim to improve care. Support of senior leadership and dedicated time and engagement of stakeholders including clinic nurses, schedulers, research, data coordinators, and administrators, were critical to this initiative. Timely data entry in the CFFPR and clinic database along with new data review processes allowed for real-time evaluation of progress and identification of barriers. Ongoing interventions aim to streamline scheduling, increase family engagement, and communicate successes. Manual extraction and dissemination of data are complex and time-consuming; EMR report automation would support ongoing metrics reviews for QI and allow expansion of this improvement framework to other key areas of CF care.

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