Improving Screening for Cystic Fibrosis–Related Diabetes at a Pediatric Cystic Fibrosis Program

OBJECTIVE: Despite guidelines recommending an annual oral glucose tolerance test (OGTT) for all patients with cystic fibrosis (CF) aged ≥10 years, screening rates for cystic fibrosis–related diabetes (CFRD) remained low at our center. The aim of this project was to implement an outpatient system to provide effective, evidence-based screening for CFRD at a pediatric CF program. METHODS: Development of a system to improve outpatient screening for CFRD included structured education, communication with families, and processes for scheduling laboratory appointments. The primary outcome measure was the proportion of eligible patients seen at the clinic who received an OGTT by the subsequent clinic appointment. The proportion of patients without CFRD in our program who received an OGTT within the previous 12 months was also tracked longitudinally. RESULTS: The outpatient screening rate for CFRD increased from 2% of eligible patients seen at the clinic during the 18 weeks before the start of our initiative to 78% during the 18 weeks after the start of our initiative ( P < .001). The screening rate was also increased from the corresponding date range the previous year, when only 35% of eligible patients received an OGTT ( P < .001). The overall percentage of patients without CFRD in our program who received an OGTT in the previous 12 months increased from 47% to 71% after implementation of our initiative ( P = .003). CONCLUSIONS: A systematic, quality improvement approach effectively increased the rate of outpatient screening for CFRD at a pediatric CF program. * Abbreviations: CF — : cystic fibrosis CFF — : Cystic Fibrosis Foundation CFRD — : cystic fibrosis–related diabetes EMR — : electronic medical record OGTT — : oral glucose tolerance test QI — : quality improvement