ABSTRACT
BACKGROUND: In 2001, Cincinnati Children's Hospital embarked on a journey to improve healthcare delivery to patients with cystic fibrosis (CF). Data from the Cystic Fibrosis Foundation National Patient Registry revealed our below-average clinical outcomes, prompting us to initiate improvement interventions. OBJECTIVE: To improve clinical outcomes for patients with CF through a comprehensive quality-improvement approach directed at increasing patient centredness and improving healthcare delivery. INTERVENTIONS: In 2001, we shared our below-average outcomes with patients, families and care providers. We instituted a quality-improvement steering committee with parental and hospital leadership, and our data-management support was restructured to provide real-time clinical data to monitor our progress. In 2002, our weekly chart conference changed to a prospective planning session and individualised daily schedules were created for inpatients. In 2003, an influenza vaccination campaign was initiated and our infection-control practices were redesigned. In 2005, best-practice guidelines were developed for airway-clearance therapy. In 2007, evidence-based clinical algorithms were designed and implemented and key care-team members were added. MEASUREMENTS: Primary outcome measures were median forced expiratory volume in 1 s per cent predicted (age range 6-17 years) and median body mass index percentile (age range 2-20 years). RESULTS: From 2000 to 2010, median forced expiratory volume in 1 s increased from 81.7% to 100.1% predicted and median body mass index increased from the 35th to the 55th centile. DISCUSSION: By focusing on specific outcomes, empowering families and patients, effectively using data, and standardising care processes, we transformed the culture and delivery of care for our patients with CF and learned valuable lessons potentially translatable to other chronic-care providers.
Subject(s)
Cystic Fibrosis/therapy , Delivery of Health Care/organization & administration , Patient Care Team/organization & administration , Quality Assurance, Health Care , Adolescent , Child , Cystic Fibrosis/physiopathology , Female , Health Care Surveys , Hospitals, Pediatric , Humans , Male , Ohio , Patient Care/methods , Program Evaluation , Quality Improvement , Time Factors , Young AdultSubject(s)
Cooperative Behavior , Heart Arrest/therapy , Hospital Rapid Response Team/organization & administration , Quality Improvement/organization & administration , Community Networks/standards , Hospitals/standards , Humans , Inservice Training/organization & administration , Intensive Care Units/organization & administration , Leadership , New York , Patient Care Team/organization & administration , Quality of Health Care/organization & administration , Time FactorsABSTRACT
OBJECTIVE: The authors examined facial expression recognition in adolescents with mood and anxiety disorders. METHOD: Standard facial emotion identification tests were given to youth with bipolar disorder (N=11) or DSM-IV anxiety disorders (N=10) and a group of healthy comparison subjects (N=25). RESULTS: Relative to the anxiety disorder and healthy comparison groups, the subjects with bipolar disorder made more emotion recognition errors when presented with faces of children. Unlike the anxious and comparison subjects, bipolar disorder youth were prone to misidentify faces as angry. No differences in emotion recognition errors were seen when the adolescents were presented with adult faces. CONCLUSIONS: A bias to misinterpret the facial expressions of peers as angry may characterize youth with bipolar disorder but not youth with anxiety disorders. This bias may relate to social impairment in youth with bipolar disorder.