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Journal of Pediatric Psychology Advance Access published online on April 14, 2009
Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsp013
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© The Author 2009. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Using Quality Improvement Science to Implement a Multidisciplinary Behavioral Intervention Targeting Pediatric Inpatient Airway Clearance

Michelle M. Ernst, PhD1,*, Jamie L. Wooldridge, MD2,*, Edward Conway, RRT3, Kathy Dressman, RN, MS, NEA-BC4, Jeanne Weiland, RN, MSN, CPNP4, Karen Tucker, RN, MSN4 and Michael Seid, PhD2,5

1Division of Behavioral Medicine and Clinical Psychology, 2Division of Pulmonary Medicine, 3Division of Respiratory Care, 4Division of Patient Services and 5Center for Health Care Quality, Division of Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center

All correspondence concerning this article should be addressed to Michelle M. Ernst, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 3015, Cincinnati, OH 45229, USA. E-mail: michelle.ernst{at}cchmc.org


  Abstract

Objective The objective of this study was to use quality improvement science methodology to develop a multidisciplinary intervention improving occurrence of best-practice airway clearance therapy (ACT) in inpatient adolescents with cystic fibrosis during routine clinical care. Methods The model for improvement was used to develop and implement interventions. Primary outcomes were quality of ACT (% ACT meeting criteria for best practice) and quantity of ACT (% of hospital days patients received ACT four times/day). Annotated control charts were used to document the impact of the interventions. Results Quality of ACT significantly improved from 21% best practice ACT at baseline to 73%. Quantity of ACT significantly improved from 41% days with ACT four times/day at baseline to 64%. Conclusions A multidisciplinary, evidence-based intervention was effective for improving occurrence of best-practice ACT. Pediatric psychology can make valuable contributions to improving the quality of care provided in the medical setting.

Key words: adherence; cystic fibrosis; evidence-based practice; research design and methods..

Received August 29, 2008; revision received February 4, 2009; accepted February 4, 2009


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