TY - JOUR
T1 - Improving rates of ferrous sulfate prescription for suspected iron deficiency anaemia in infants
AU - Rea, Corinna J.
AU - Bottino, Clement
AU - Yuen, Jenny Chan
AU - Conroy, Kathleen
AU - Cox, Joanne
AU - Epee-Bounya, Alexandra
AU - Kamalia, Radhika
AU - Meleedy-Rey, Patricia
AU - Pethe, Kalpana
AU - Samuels, Ronald
AU - Schubert, Pamela
AU - Starmer, Amy J.
N1 - Funding Information:
This study has been supported by Boston Children's Hospital Department of Pediatrics Quality Program and the Division of General Pediatrics.
Funding Information:
Funding This study has been supported by Boston Children's
Publisher Copyright:
© 2019 Author(s).
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Background Iron deficiency anaemia (IDA) in infancy is prevalent and associated with impaired neurodevelopment; however, studies suggest that treatment and follow-up rates are poor. Objectives To improve the rate of ferrous sulfate prescription for suspected IDA among infants aged 8-13 months to 75% or greater within 24 months. Methods We implemented a multidisciplinary process improvement effort aimed at standardising treatment for suspected IDA at two academic paediatric primary care clinics. We developed a clinical pathway with screening and treatment recommendations, followed by multiple plan-do-study-act cycles including provider education, targeted reminders when ferrous sulfate was not prescribed and development of standardised procedures for responding to abnormal lab values. We tracked prescription and screening rates using statistical process control charts. In post hoc analyses, we examined rates of haemoglobin (Hgb) recheck and normalisation for the preintervention versus postintervention groups. Results The prescription rate for suspected IDA increased from 41% to 78% following implementation of the intervention. Common reasons for treatment failure included prescription of a multivitamin instead of ferrous sulfate, and Hgb not flagged as low by the electronic medical record. Screening rates remained stable at 89%. Forty-one per cent of patients with anaemia in the preintervention group had their Hgb rechecked within 6 months, compared with 56% in the postintervention group (p<0.001). Furthermore, 30% of patients with anaemia in the postintervention group had normalised their Hgb by 6 months, compared with 20% in the preintervention group (p<0.05). Conclusions A multipronged interdisciplinary quality improvement intervention enabled: (1) development of standardised practices for treating suspected IDA among infants aged 8-13 months, (2) improvement of prescription rates and (3) maintenance of high screening rates. Rates of Hgb recheck and normalisation also increased in the intervention period.
AB - Background Iron deficiency anaemia (IDA) in infancy is prevalent and associated with impaired neurodevelopment; however, studies suggest that treatment and follow-up rates are poor. Objectives To improve the rate of ferrous sulfate prescription for suspected IDA among infants aged 8-13 months to 75% or greater within 24 months. Methods We implemented a multidisciplinary process improvement effort aimed at standardising treatment for suspected IDA at two academic paediatric primary care clinics. We developed a clinical pathway with screening and treatment recommendations, followed by multiple plan-do-study-act cycles including provider education, targeted reminders when ferrous sulfate was not prescribed and development of standardised procedures for responding to abnormal lab values. We tracked prescription and screening rates using statistical process control charts. In post hoc analyses, we examined rates of haemoglobin (Hgb) recheck and normalisation for the preintervention versus postintervention groups. Results The prescription rate for suspected IDA increased from 41% to 78% following implementation of the intervention. Common reasons for treatment failure included prescription of a multivitamin instead of ferrous sulfate, and Hgb not flagged as low by the electronic medical record. Screening rates remained stable at 89%. Forty-one per cent of patients with anaemia in the preintervention group had their Hgb rechecked within 6 months, compared with 56% in the postintervention group (p<0.001). Furthermore, 30% of patients with anaemia in the postintervention group had normalised their Hgb by 6 months, compared with 20% in the preintervention group (p<0.05). Conclusions A multipronged interdisciplinary quality improvement intervention enabled: (1) development of standardised practices for treating suspected IDA among infants aged 8-13 months, (2) improvement of prescription rates and (3) maintenance of high screening rates. Rates of Hgb recheck and normalisation also increased in the intervention period.
KW - clinical practice guidelines
KW - control charts, run charts
KW - paediatrics
KW - primary care
KW - quality improvement
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U2 - 10.1136/bmjqs-2018-009098
DO - 10.1136/bmjqs-2018-009098
M3 - Article
C2 - 30971434
AN - SCOPUS:85064205343
SN - 2044-5415
VL - 28
SP - 588
EP - 597
JO - Quality in Health Care
JF - Quality in Health Care
IS - 7
ER -
