(67) Implementation of a health screening process for cystic fibrosis care during the COVID-19 pandemic

Thursday, November 3, 2022

12:45 PM – 1:25 PM ET

Presenting Author(s)

Brielle Evangelista, MS RDN

Registered Dietitian
University of Virginia Health System
Charlottesville, Virginia, United States

Co-Author(s)

RM

Rachel K. Murray, MS, RDN

Registered Dietitian Nutritionist
UVA Health System
Charlottesville, Virginia, United States
Rhonda List

Quality Improvement Coordinator
University of Virginia Health System
Ruckersville, Virginia, United States
Dana Albon, MD, MS, FCCP

Cystic Fibrosis Adult Program Medical Director
UVA Health System
Charlottesville, Virginia, United States
Heather Bruschwein, PsyD

Licensed Clinical Psychologist, Assistant Professor of Psychiatry & Neurobehavioral Sciences
UVA Health System, United States
Martina Compton, RRT-NPS RPFT

Respiratory Therapist
University of Virginia
Crozet, Virginia, United States
Deirdre Jennings, MSW, LCSW (she/her/hers)

Clinical Social Worker
University of Virginia Health System, United States
RT

Rachel Turner

Administration Assistant
University of Virginia, United States
LS

Lindsay Somerville, MD

Associate Director of Adult Cystic Fibrosis Program
University of Virginia Health System, United States

Background: Cystic Fibrosis (CF) is associated with complications such as cystic fibrosis-related diabetes (CFRD) and bone disease. The CF Foundation advises routine screenings as the standard care for early identification and treatment of these complications. Specifically, the Foundation recommends annual completion of an oral glucose tolerance test (OGTT) and a dual-energy X-ray absorptiometry (DEXA) bone density scan at least every 5 years. In 2019, 55% of eligible patients completed an OGTT and 68% completed a DEXA scan at UVA Health System (UVAHS). As the majority of in-person clinic visits transitioned to telemedicine during 2020 and 2021, increased barriers impacted completion of health screenings. The UVAHS team utilized quality improvement (QI) tools to design a process to maintain and improve OGTT and DEXA completion rates with the new hybrid nature of clinical care. The aim of this project is to define a replicable and reliable process for obtaining health screenings in the setting of hybrid patient care.

Methods: Quality improvement tools implicated in the Model for Improvement methodology guided production of a Simplified Failure Mode Effects Analysis (sFMEA) to identify areas for intervention. Subsequently, a process was developed to track patient eligibility and completion of screenings and adapted through iterative Plan-Do-Study-Act (PDSA) cycles. CF registered dietitians (RDs) documented completion of OGTTs and DEXAs in a secure Excel spreadsheet coded to flag patients due for each health screening. Two weeks before clinic, both RDs referenced the spreadsheet to determine patients due for health screenings. All identified patients were contacted to inform them of the health screening(s) due. Patients and RDs then co-produced a plan for completion of the health screening(s), either at an in-person visit, at a local lab, or in conjunction with a non-CF healthcare appointment. Regardless of the decided plan, patients were provided outpatient lab order requisitions. To ensure communication with other care team members, patients contacted about their screening(s) and scheduled for their screening(s) were denoted in the shared, HIPAA compliant clinic tracking platform. Clinic nurses received outside lab results via fax and all in-house results through the electronic medical records system. Once labs were reviewed and communicated with the patient, the health screening spreadsheet was updated.

Results: In both 2020 and 2021, 39% of eligible patients completed an OGTT, and 76% of eligible patients completed a DEXA scan. Of those who completed an OGTT in 2020 and 2021, 68% and 74%, respectively indicated abnormal results consistent with either impaired fasting glucose tolerance or CF related diabetes. The majority of patients with up-to-date DEXA scans by the end of 2021 were positive for osteopenia or osteoporosis (53%).

Conclusions: Through the creation of a standardized protocol utilizing iterative PDSA cycles, patients continued to sustain routine health screenings despite reduced in-person clinic visits. This allowed for identification and intervention for many patients regarding diabetes and bone health. Continuation of this protocol will further enhance our ability to collect patient health screenings while providing the same high-quality care via telemedicine as we provide with in-person visits.

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