2002 OPEN FORUM Abstracts
Disease Management of Cystic Fibrosis in a Children’s Hospital
Teresa A. Volsko, BS, RRT, FAARC, Robert L. Chatburn BS, RRT, FAARC, Sally Lambert, PhD, RN, Michael W. Konstan MD, University Hospitals of Cleveland, Case Western Reserve University
Objective: To evaluate disease management of cystic fibrosis (CF) in pediatric patients using a care manager and a standardized care path (CP). Outcome variables were: hospital length of stay, quality (completed airway clearance therapies, completed nutrition assessments, readmission due to failed home intravenous antibiotic use) and efficiency (delay of initial intravenous antibiotic administration, home IV antibiotic use).
Methods: Our interdisciplinary team developed a care path for the treatment of an acute pulmonary exacerbation which included practice guidelines for nutrition evaluation and support, airway clearance regimens, and orders for laboratory and diagnostic tests. This study was comprised of 131 consecutive patients, ²18 years of age that were admitted to Rainbow Babies and Children’s Hospital for treatment of an acute pulmonary exacerbation CF between January 1, 2000 and December 31, 2001. All patients were treated according to the standardized care path. Baseline length of stay data, mean antibiotic time to administration, and home IV antibiotic use were obtained from a retrospective review of all CF related hospitalizations from January 1 to December 31, 1999. Patients admitted for reasons other than an acute pulmonary exacerbation were excluded along with those with significant co-morbidities. Pre-care path data specific to missed nutrition evaluations and missed airway clearance treatments were obtained from chart review of a matched sample of patients, identified in the baseline group, to those analyzed in the post implementation group, admitted from November 12 to December 31, 1999. Data were analyzed wit Mann-Whitney Rank Sum tests and Chi-Square tests.
Results: Outcome data in percent or mean values (±SD) are shown in the table below (pre and post care path implementation):
| Pre | Post | p | ||
| Number in study | 72 | 131 | — | |
| Hospital LOS (days) | 14.0 (6.8 | 11.5 (6.3) | 0.010 | |
| Home IV antibiotic use (%) | 20.3 | 41.5 | <0.001 | |
| Missed respiratory treatments (%) | 25.3 | 7.3 | <0.001 | |
| Missed nutrition evaluations (%) | 35.7 | 18.1 | 0.200 | |
| Delay of antibiotic administration (hours) | 5.8 (2.1 | 0.7 (1.4) | <0.001 | |
| Failed home IV antibiotic therapy | Not available | 12.2 | — | |
Pre care path data for home IV antibiotic rate were not available. The power for the test nutrition evaluations was only 0.23.
Conclusion: Active disease management of cystic fibrosis, using a care manager and a standardized care path, decreased length of stay and improved both quality and efficiency outcomes.
OF-02-035