(76) Increased dietitian/patient contact improves anthropometric outcomes in 0-24 month old children with cystic fibrosis (CF)

Background: In 2020, Geisinger’s Pediatric CF clinic’s median weight-for-length on WHO growth charts in patients < 24 months was 31%ile compared to 63%ile for all eligible programs. Overall, median weight-for-length had been declining over the past three years. The CF Foundation (CFF) recommends weight-for-length above the 50%ile for all patients 0-12 months of age and above the 75%ile for all patients 12-24 months of age. Our aim was to improve median weight-for-length in patients < 24 months of age.

Methods: Geisinger serves over 750,000 children in nearly 40 counties across Pennsylvania; most living in rural areas. Geisinger’s Pediatric CF clinic serves 70-75 patients. The dietitian was allotted 0.1 full time equivalents (FTE) or 4 hours/week for CF care. In January 2021, we began implementing the recommendations for dietitian evaluation and monitoring for all patients < 36 months based on the CFF guidelines. Guidelines recommend nutrition evaluation monthly for children < 6 months of age, every other month for children 6-12 months of age, and every 3 months for children > 1 year of age. Patients not meeting their weight goals were followed closely. Patients < 6 months of age received a home scale through grant funding to allow for frequent weight checks. Throughout the quality improvement (QI) initiative, there were 14 eligible patients < 36 months, and 8 of these patients were < 24 months. Telehealth was utilized due to frequency of visits and distance of the care center from patients’ homes. Anthropometrics were measured during clinic visits and telehealth visits. Dietitian visits and contact outside of visits (phone calls and patient portal messages) were tracked. With the support of the CF center director, clinical nutrition leadership was approached about expanding the role of the CF dietitian. Justification used to increase dietitian FTE included comparisons to other centers and Geisinger’s adult CF clinic program as well as the CFF’s recommendation of 1.0 dietitian FTE per 100-200 CF patients. In April 2021, dietitian time was increased to 0.2 FTE (8 hours/week) and in July 2021, the position was increased to 0.5 FTE (20 hours/week) through grant funding.

Results: In 2021, the dietitian participated in 71 visits, 24 patient portal messages, and 10 phone calls with patients < 36 months. All eligible patients were assessed at least once. In patients < 24 months, 8 patients were assessed by the dietitian 51 times, averaging 6.4 dietitian visits/patient/year. This is a 73% increase in dietitian assessments from the previous year (1.6 visits/patient/year). Co-production of care improved with increased family engagement and participation in developing and modifying nutrition care plans. Over the 12 months of the QI initiative, median WHO weight-for-length in patients < 24 months improved from 31%ile to 55%ile.

Conclusions: Dedicated dietitian time in CF clinic supported by an increase in FTE resulted in improved dietitian/patient communication and increased median weight-for-length percentiles in patients < 24 months of age. The use of telehealth allowed for earlier and more frequent interventions resulting in improved weight gain. Sustainability of this QI initiative is dependent on continued FTE support through grant funding as well as the use of telehealth to evaluate patients between regular CF clinic visits.

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