Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting

Abstract Background. The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of...

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Veröffentlicht in:Physical therapy 2017-06, Vol.97 (6), p.649-658
Hauptverfasser: Strenk, Mariann L., Kiger, Michelle, Hawke, Jesse L., Mischnick, Amy, Quatman-Yates, Catherine
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container_end_page 658
container_issue 6
container_start_page 649
container_title Physical therapy
container_volume 97
creator Strenk, Mariann L.
Kiger, Michelle
Hawke, Jesse L.
Mischnick, Amy
Quatman-Yates, Catherine
description Abstract Background. The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of patients who achieved resolution of CMT within 6 months of evaluation. Objective. The aims of this report are to describe the QI activities conducted to improve patient outcomes and discuss the results and implications for other institutions and patient populations. Design. This was a quality improvement study. Methods. In alignment with the Chronic Care Model and Model of Improvement, an aim and operationally defined key outcome and process measures were established. Interventions were tested using Plan-Do-Study-Act cycles. A CMT registry was established to store and manage data extracted from the electronic record over the course of testing. Statistical process control charts were used to monitor progress over time. Results. The QI initiative resulted in an increase in the percentage of patients who achieved full resolution of CMT within a 6-month episode of care from 42% to 61% over an 18-month period. Themes that emerged as key drivers of improvement included: (1) timely, optimal access to care, (2) effective audit and clinician feedback, and (3) accurate, timely documentation. Limitations. The initiative took place at a single institution with a supportive culture and strong QI resources, which may limit direct translation of interventions and findings to other institutions and patient populations. Conclusions. Improvement science methodologies provided the tools and structure to improve division-wide workflow and increase consistency in the implementation of the APTA CMT guideline. In doing so, significant CMT population outcome improvements were achieved.
doi_str_mv 10.1093/ptj/pzx029
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The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of patients who achieved resolution of CMT within 6 months of evaluation. Objective. The aims of this report are to describe the QI activities conducted to improve patient outcomes and discuss the results and implications for other institutions and patient populations. Design. This was a quality improvement study. Methods. In alignment with the Chronic Care Model and Model of Improvement, an aim and operationally defined key outcome and process measures were established. Interventions were tested using Plan-Do-Study-Act cycles. A CMT registry was established to store and manage data extracted from the electronic record over the course of testing. Statistical process control charts were used to monitor progress over time. Results. The QI initiative resulted in an increase in the percentage of patients who achieved full resolution of CMT within a 6-month episode of care from 42% to 61% over an 18-month period. Themes that emerged as key drivers of improvement included: (1) timely, optimal access to care, (2) effective audit and clinician feedback, and (3) accurate, timely documentation. Limitations. The initiative took place at a single institution with a supportive culture and strong QI resources, which may limit direct translation of interventions and findings to other institutions and patient populations. Conclusions. Improvement science methodologies provided the tools and structure to improve division-wide workflow and increase consistency in the implementation of the APTA CMT guideline. In doing so, significant CMT population outcome improvements were achieved.</description><identifier>ISSN: 0031-9023</identifier><identifier>EISSN: 1538-6724</identifier><identifier>DOI: 10.1093/ptj/pzx029</identifier><identifier>PMID: 28371924</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Alcohol ; Ambulatory care ; Analysis ; Care and treatment ; Chronic illnesses ; Clinical outcomes ; Evidence-Based Practice ; Female ; Health care access ; Humans ; Infant ; Infant, Newborn ; Male ; Medical errors ; Patients ; Pediatrics ; Physical therapy ; Physical Therapy Modalities ; Practice Guidelines as Topic ; Primary care ; Process controls ; Quality ; Quality control ; Quality Improvement ; Quality of life ; Registries ; Studies ; Therapeutics, Physiological ; Torticollis ; Torticollis - congenital ; Torticollis - rehabilitation ; Treatment Outcome</subject><ispartof>Physical therapy, 2017-06, Vol.97 (6), p.649-658</ispartof><rights>2017 American Physical Therapy Association 2017</rights><rights>2017 American Physical Therapy Association</rights><rights>COPYRIGHT 2017 Oxford University Press</rights><rights>Copyright Oxford University Press, UK Jun 2017</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c626t-96b9bf4df1b16151c5ec8583d6e6bc7aa7fe84dbfccb1b8d5052d315d76482753</citedby><cites>FETCH-LOGICAL-c626t-96b9bf4df1b16151c5ec8583d6e6bc7aa7fe84dbfccb1b8d5052d315d76482753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28371924$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Strenk, Mariann L.</creatorcontrib><creatorcontrib>Kiger, Michelle</creatorcontrib><creatorcontrib>Hawke, Jesse L.</creatorcontrib><creatorcontrib>Mischnick, Amy</creatorcontrib><creatorcontrib>Quatman-Yates, Catherine</creatorcontrib><title>Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting</title><title>Physical therapy</title><addtitle>Phys Ther</addtitle><description>Abstract Background. The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of patients who achieved resolution of CMT within 6 months of evaluation. Objective. The aims of this report are to describe the QI activities conducted to improve patient outcomes and discuss the results and implications for other institutions and patient populations. Design. This was a quality improvement study. Methods. In alignment with the Chronic Care Model and Model of Improvement, an aim and operationally defined key outcome and process measures were established. Interventions were tested using Plan-Do-Study-Act cycles. A CMT registry was established to store and manage data extracted from the electronic record over the course of testing. Statistical process control charts were used to monitor progress over time. Results. The QI initiative resulted in an increase in the percentage of patients who achieved full resolution of CMT within a 6-month episode of care from 42% to 61% over an 18-month period. Themes that emerged as key drivers of improvement included: (1) timely, optimal access to care, (2) effective audit and clinician feedback, and (3) accurate, timely documentation. Limitations. The initiative took place at a single institution with a supportive culture and strong QI resources, which may limit direct translation of interventions and findings to other institutions and patient populations. Conclusions. Improvement science methodologies provided the tools and structure to improve division-wide workflow and increase consistency in the implementation of the APTA CMT guideline. 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The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of patients who achieved resolution of CMT within 6 months of evaluation. Objective. The aims of this report are to describe the QI activities conducted to improve patient outcomes and discuss the results and implications for other institutions and patient populations. Design. This was a quality improvement study. Methods. In alignment with the Chronic Care Model and Model of Improvement, an aim and operationally defined key outcome and process measures were established. Interventions were tested using Plan-Do-Study-Act cycles. A CMT registry was established to store and manage data extracted from the electronic record over the course of testing. Statistical process control charts were used to monitor progress over time. Results. The QI initiative resulted in an increase in the percentage of patients who achieved full resolution of CMT within a 6-month episode of care from 42% to 61% over an 18-month period. Themes that emerged as key drivers of improvement included: (1) timely, optimal access to care, (2) effective audit and clinician feedback, and (3) accurate, timely documentation. Limitations. The initiative took place at a single institution with a supportive culture and strong QI resources, which may limit direct translation of interventions and findings to other institutions and patient populations. Conclusions. Improvement science methodologies provided the tools and structure to improve division-wide workflow and increase consistency in the implementation of the APTA CMT guideline. 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source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection
subjects Alcohol
Ambulatory care
Analysis
Care and treatment
Chronic illnesses
Clinical outcomes
Evidence-Based Practice
Female
Health care access
Humans
Infant
Infant, Newborn
Male
Medical errors
Patients
Pediatrics
Physical therapy
Physical Therapy Modalities
Practice Guidelines as Topic
Primary care
Process controls
Quality
Quality control
Quality Improvement
Quality of life
Registries
Studies
Therapeutics, Physiological
Torticollis
Torticollis - congenital
Torticollis - rehabilitation
Treatment Outcome
title Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting
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