Assessing Adherence to Audiologic Parameters of Care for Children With Cleft Palate: A Quality Improvement Initiative.

Abstract

OBJECTIVE\nTo evaluate and increase adherence to an evidence-based audiologic management protocol for children with cleft palate.\n\n\nDESIGN\nProspective, multidisciplinary quality improvement initiative.\n\n\nSETTING\nTertiary pediatric hospital.\n\n\nPATIENTS, PARTICIPANTS\nChildren with cleft palate (with or without cleft lip) between the ages of 0 and 5 years (n = 205).\n\n\nINTERVENTIONS\nA multidisciplinary team identified key drivers for nonadherence to recommended audiological follow-up and implemented interventions to improve adherence. Key drivers included provider practices and preferences, clinic logistics and flow, and patient/family awareness and education. Several interventions were implemented between 2016 and 2020, including developing an evidence-based audiologic protocol, maximizing access to audiologic clinic visits across multiple departments, cleft team education, and improved team communication.\n\n\nMAIN OUTCOME MEASURE(S)\nCompletion of recommended audiologic assessment at 5 separate care milestones.\n\n\nRESULTS\nAfter implementation of interventions between 2016 and 2020, adherence to recommended audiologic follow-up increased from 59% to 84%. Analysis of individual care milestones revealed that increased access to audiologic testing during team clinics resulted in the largest increase in adherence to recommended follow-up. Additionally, cause-effect analysis revealed that nonadherence due to provider-related causes decreased over the project period to a greater extent than patient/family-related causes.\n\n\nCONCLUSIONS\nImplementation of an evidence-based audiologic care protocol and improvements in access to early hearing care are feasible in a high-volume multidisciplinary cleft clinic. Adherence to recommended audiologic management can be improved by establishing strategies to improve access to care, team member and family education, and enhanced team communication.