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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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 |
format | Article |
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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.</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. In doing so, significant CMT population outcome improvements were achieved.</description><subject>Alcohol</subject><subject>Ambulatory care</subject><subject>Analysis</subject><subject>Care and treatment</subject><subject>Chronic illnesses</subject><subject>Clinical outcomes</subject><subject>Evidence-Based Practice</subject><subject>Female</subject><subject>Health care access</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Medical errors</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Physical therapy</subject><subject>Physical Therapy Modalities</subject><subject>Practice Guidelines as Topic</subject><subject>Primary care</subject><subject>Process controls</subject><subject>Quality</subject><subject>Quality control</subject><subject>Quality Improvement</subject><subject>Quality of life</subject><subject>Registries</subject><subject>Studies</subject><subject>Therapeutics, Physiological</subject><subject>Torticollis</subject><subject>Torticollis - congenital</subject><subject>Torticollis - rehabilitation</subject><subject>Treatment Outcome</subject><issn>0031-9023</issn><issn>1538-6724</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqV0uFr1DAUAPAiipvTL_4BEhBBhW5J06St38ah28HpoZufQ5q-lhxp0yXp2Pzmf25ud1NOjqHkQyDv9x7Jy0uSlwQfE1zRkzGsTsYfNzirHiWHhNEy5UWWP04OMaYkrXBGD5Jn3q8wxqTIq6fJQVbSglRZfpj8nPejgR6GIIO2A7ItkujrJI0OtyjGnL2-i6L5oIOO5ho-3J83aGaHDmJAGvR58moy0qFL64JW1hjt0XIKyvbgkR5i2YV0HaBz68e7jAsIQQ_d8-RJK42HF9v9KPn-6ePl7DxdLM_ms9NFqnjGQ1rxuqrbvGlJTThhRDFQJStpw4HXqpCyaKHMm7pVqiZ12TDMsoYS1hQ8L7OC0aPk7aZuvPvVBD6IXnsFxsgB7OQFKcuccMpIHunrv-jKTm6ItxOk4gUllGD-R3XSgNBDa4OTal1UnLLYasqyrIoq3aNi18BJYwdodTze8cd7fFwN9LGt-xLe7SREE-AmdHLyXswvvv2H_fLPtjxbPPTIrV1PAXQg4j_Olrv-_cYrZ7130IrR6V66W0GwWM-0iDMtNjMd8avtb0x1D81vej_EEbzZADuNDxX6BSMo-30</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Strenk, Mariann L.</creator><creator>Kiger, Michelle</creator><creator>Hawke, Jesse L.</creator><creator>Mischnick, Amy</creator><creator>Quatman-Yates, Catherine</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7RQ</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>88I</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20170601</creationdate><title>Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting</title><author>Strenk, Mariann L. ; Kiger, Michelle ; Hawke, Jesse L. ; Mischnick, Amy ; Quatman-Yates, Catherine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c626t-96b9bf4df1b16151c5ec8583d6e6bc7aa7fe84dbfccb1b8d5052d315d76482753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Alcohol</topic><topic>Ambulatory care</topic><topic>Analysis</topic><topic>Care and treatment</topic><topic>Chronic illnesses</topic><topic>Clinical outcomes</topic><topic>Evidence-Based Practice</topic><topic>Female</topic><topic>Health care access</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Medical errors</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Physical therapy</topic><topic>Physical Therapy Modalities</topic><topic>Practice Guidelines as Topic</topic><topic>Primary care</topic><topic>Process controls</topic><topic>Quality</topic><topic>Quality control</topic><topic>Quality Improvement</topic><topic>Quality of life</topic><topic>Registries</topic><topic>Studies</topic><topic>Therapeutics, Physiological</topic><topic>Torticollis</topic><topic>Torticollis - congenital</topic><topic>Torticollis - rehabilitation</topic><topic>Treatment Outcome</topic><toplevel>online_resources</toplevel><creatorcontrib>Strenk, Mariann L.</creatorcontrib><creatorcontrib>Kiger, Michelle</creatorcontrib><creatorcontrib>Hawke, Jesse L.</creatorcontrib><creatorcontrib>Mischnick, Amy</creatorcontrib><creatorcontrib>Quatman-Yates, Catherine</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Career & Technical Education Database</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Physical therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Strenk, Mariann L.</au><au>Kiger, Michelle</au><au>Hawke, Jesse L.</au><au>Mischnick, Amy</au><au>Quatman-Yates, Catherine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting</atitle><jtitle>Physical therapy</jtitle><addtitle>Phys Ther</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>97</volume><issue>6</issue><spage>649</spage><epage>658</epage><pages>649-658</pages><issn>0031-9023</issn><eissn>1538-6724</eissn><abstract>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.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>28371924</pmid><doi>10.1093/ptj/pzx029</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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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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