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Quality improvement report
Improved outcomes in cystic fibrosis using modified Re-Education of Airway Clearance Technique (REACT) programme
  1. Courtney Reamer1,
  2. Catherine O'Malley2,
  3. Julie Nufer2,
  4. Adrienne Savant1,2
  1. 1Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
  2. 2Division of Pulmonary Medicine, Department of Pediatrics, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Adrienne Savant; adriennesavant{at}gmail.com

Abstract

Background and objectives Cystic fibrosis (CF) is known to reduce lung function as measured by per cent predicted for the forced expiratory volume in the first second (ppFEV1) over time. Our paediatric CF programme demonstrated significant gaps in benchmarked ppFEV1 predicted compared with the national median. Our objective was to assess whether the implementation of a modified Re-Education of Airway Clearance Techniques (REACT) programme could lead to an improvement in lung function as measured by ppFEV1.

Methods This 2-year prospective quality improvement study at Lurie Children’s CF Center for children aged >6 years used improvement methodology to implement a modified REACT programme. Outcome measures were assessed for our entire programme via the CF Foundation Patient Registry (CFFPR) and statistical process control. Comparisons were also made before and after REACT for outcome measures.

Results By the end of implementation, monthly participation rate achieved 100%. Using CFFPR data and SPC, median ppFEV1 increased by 3.9%, whereas only body mass index (BMI) as a secondary outcome increased. Comparison of pre and post REACT showed improvements in average ppFEV1 (95% vs 96%, p<0.0001), FEF25%−75% (82% vs 83%, p=0.0590), rate of ppFEV1 decline (+2% vs −4%, p=0.0262) and BMI percentile (57% vs 60%, p<0.0001).

Conclusions Implementation of a modified REACT at Lurie Children’s paediatric CF programme led to an increase in ppFEV1, FEF25%−75% and BMI percentile.

  • clinical microsystem
  • control charts/run charts
  • education
  • paediatrics
  • quality improvement
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2019-000890

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    Footnotes

    • Contributors CR conceptualised and designed the study, analysed the data, drafted the initial manuscript, and reviewed and revised the manuscript critically for important intellectual content. CO'M conceptualised and designed the study, collected data, drafted the initial study, and reviewed and revised the manuscript critically for important intellectual content. JN acquired the data and reviewed and revised the article critically for important intellectual content. AS conceptualised and designed the study, analyzed and interpreted the data, drafted the article, and reviewed and revised it critically for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon request.