(7) One center’s journey to improve the endocrine health of our patients

Background: Data shows that 20% of children and 50% of adults with Cystic Fibrosis (CF) are affected by Cystic Fibrosis Related Diabetes (CFRD). CFRD can occur without symptoms, therefore annual screening starting at age 10 is recommended by the Cystic Fibrosis Foundation (CFF). In 2020, registry data revealed that the University of Mississippi Medical Center (UMMC) fell below the national average for Oral Glucose Tolerance Test (OGTT) screenings. The national median for OGTT screening in non-diabetic patients 10 years and older was 51.3%, with UMMC completing only 43.8% of screenings in the target population. As impaired glucose tolerance (IGT) is associated with pulmonary function deterioration and risk of progression to diabetes, our goal was to increase the number of patients completing OGTTs. The target population for the intervention was patients greater than 10 years of age due to CFF guidelines.

Methods: A multidisciplinary team was assembled including the CF center director, center coordinator, dietitian, social worker, nurses, respiratory therapists, pharmacists, Endocrine physician, and parents of a patient with CF. The team met weekly and participated in the Virtual Improvement Program Fundamentals (VIP-F7) quality improvement course. An assessment of our patients 10 years and older who completed an OGTT was completed by reviewing the center specific data for 2021. Global and specific aims for improvement were written. The team developed a flowchart assessing current practices for completing OGTTs and ideas for change were evaluated using a Plan-Do-Study-Act (PDSA) Model. Using the PDSA model a number of change ideas were tested including:

1. Identify patients needing OGTT during weekly huddle meeting. Prior to starting our VIP-F7 cycle, there was not a systematic identification method for patients needing annual screening.

2. Increase reminders for patients completing OGTTs at UMMC and locally at outside facilities. Reminders for UMMC OGTTs are provided the week prior to the patient’s pulmonology appointment. Local OGTTs completed at outside facilities are provided 6 weeks prior to next appointment at UMMC. Since implementing patient reminders, only 1 out of 7 patients have arrived for their scheduled OGTT without being fasted.

3. Start a combined Endocrinology and Pulmonology multidisciplinary clinic. Prior to starting our VIP-F7 cycle, our center had 36 patients older than 10 of which 18 had some form of glucose intolerance. However, only 50% of those patients had established care with Endocrinology.

Results: Prior to the start of the VIP-F7 cycle in October 2021, 13 patients 10 years and older completed an OGTT in 2021. As of March 2022, 7 patients 10 years and older have completed an OGTT screening. UMMC is on track for 21 patients to complete an OGTT by October 2022 when the VIP-F7 cycle concludes. The number of patients established with Endocrinology care also increased from 5 in 2021 to 8 as of March 2022, representing a 160% increase.

Conclusions: This project resulted in increased focus on endocrine health amongst all disciplines and improved the screening and completion process of OGTTs in our target population. Our center has also expanded our multidisciplinary approach by creating a combined Endocrinology-Pulmonology clinic.

Acknowledgements: This project was supported by the CFF through the Virtual Improvement Program Fundamentals.

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