Implementation of cystic fibrosis clinical pathways improved physician adherence to care guidelines

Pediatr Pulmonol. 2017 Feb;52(2):175-181. doi: 10.1002/ppul.23635. Epub 2016 Oct 31.


Introduction: There is significant variability in clinical outcomes, including growth and lung function, between the various cystic fibrosis (CF) centers. No specific or unique therapeutic practices have been identified to account for these differences. However, more uniform care within centers was associated with better outcomes. The objective of this study was to implement clinical pathways for diagnosis and treatment of nutritional failure and lung inflammation in order to achieve better health care provider adherence to center-specific, agreed-on practices.

Methods: Agreed-on clinical pathway treatment plans for both nutrition and lower airway inflammation were implemented on January 1, 2010. The primary outcome measure was to evaluate if patients' diagnoses and treatments were consistent with the agreed-on clinical pathways.

Results: The proportion of clinic visits from baseline to 18 months post-intervention where the provider completely followed nutrition clinical pathway increased from 57.72% to 79.49% (P = 0.049) and the proportion for lower airway inflammation clinical pathway increased from 65.85% to 86.32% (P = 0.035). The use of nutritional diagnosis and documentation of associated clinical pathway in the clinical plan increased from 16.26% to 61.54% and 56.10% to 94.87%, respectively. Similarly, diagnosis of lower airway inflammation and documentation related to their treatment plans increased from 1.63% to 43.59% and 30.08% to 87.18%, respectively.

Conclusion: Implementation of clinical pathways for nutrition and lower airway inflammation issues resulted in more uniform care of CF patients. Having objective criteria for diagnoses and agreed-on treatment plans for each of those diagnoses allowed for monitoring and individual feedback. Increases in utilization of correct diagnoses and discussion of specific therapeutic interventions in the clinic notes were associated with increased adherence to clinical pathways. Pediatr Pulmonol. 2017;52:175-181. © 2016 Wiley Periodicals, Inc.

Keywords: bronchoscopy; cystic fibrosis; imaging; inflammation; nutrition; quality improvement.

MeSH terms

  • Bronchoalveolar Lavage Fluid
  • Cough
  • Critical Pathways*
  • Cystic Fibrosis / therapy*
  • Disease Management
  • Documentation
  • Guideline Adherence*
  • Humans
  • Inflammation
  • Lung / diagnostic imaging
  • Malnutrition / diagnosis*
  • Malnutrition / therapy
  • Nutrition Assessment
  • Nutritional Status
  • Physicians
  • Pneumonia / diagnosis*
  • Pneumonia / therapy
  • Practice Guidelines as Topic*
  • Quality Improvement
  • Risk Assessment
  • Tomography, X-Ray Computed