A-178 Quality Improvement of Cystic Fibrosis-Related Diabetes Screening at a Large Pediatric Center

Abstract Background Cystic Fibrosis Foundation guidelines recommend annual diabetes screening by oral glucose tolerance test in pediatric patients with cystic fibrosis starting at the age of 10 years. Adherence to these guidelines proves to be challenging, and the nationwide screening rates are still considered suboptimal. The aim of this study is to assess and improve the screening rates at our large pediatric center. Methods A four-year retrospective audit of oral glucose tolerance test completion among pediatric patients with cystic fibrosis of age >10 years who have not yet been diagnosed with diabetes was conducted. A collaborative working group with the cystic fibrosis center was formed to identify the barriers to screening (Figure 1) and formulate a quality improvement plan, which was evaluated for a 9-month period post-intervention. The 3 key interventions included: 1) scheduling annual summer labs for all the eligible patients, 2) best practice advisory to guide providers with oral glucose tolerance test ordering, and 3) a streamlined process for oral glucose tolerance test appointments at the outpatient lab. Results The diabetes screening rates determined by oral glucose tolerance test completion at our center showed a gradual decline during the COVID-19 pandemic from 2019 to 2022. Following the implementation of the quality improvement plan during the summer of 2023, there was a marked increase in test ordering compliance by the provider as well as test completion by the patients. Notably, the fractional test completion rate rose from 45% during the pre-intervention phase (January-April, 2023) to 70% during the post-intervention phase (May-September, 2023). Conclusions Diabetes screening in pediatric patients with cystic fibrosis can be effectively improved by refining the practices related to patient experience, care coordination and laboratory testing strategies.