Network Implementation of Guideline for Early Detection Decreases Age at Cerebral Palsy Diagnosis.
Journal
Pediatrics
ISSN: 1098-4275
Titre abrégé: Pediatrics
Pays: United States
ID NLM: 0376422
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
accepted:
13
01
2020
pubmed:
10
4
2020
medline:
22
7
2020
entrez:
10
4
2020
Statut:
ppublish
Résumé
Early diagnosis of cerebral palsy (CP) is critical in obtaining evidence-based interventions when plasticity is greatest. In 2017, international guidelines for early detection of CP were published on the basis of a systematic review of evidence. Our study aim was to reduce the age at CP diagnosis throughout a network of 5 diverse US high-risk infant follow-up programs through consistent implementation of these guidelines. The study leveraged plan-do-study-act and Lean methodologies. The primary outcome was age at CP diagnosis. Data were acquired during the corresponding 9-month baseline and quarterly throughout study. Balancing measures were clinic no-show rates and parent perception of the diagnosis visit. Clinic teams conducted strengths, weaknesses, opportunities, and threats analyses, process flow evaluations, standardized assessments training, and parent questionnaires. Performance of a 3- to 4-month clinic visit was a critical process step because it included a Hammersmith Infant Neurologic Examination, a General Movements Assessment, and standardized assessments of motor function. The age at CP diagnosis decreased from a weighted average of 19.5 (95% confidence interval 16.2 to 22.8) to 9.5 months (95% confidence interval 4.5 to 14.6), with Large-scale implementation of international guidelines for early detection of CP is feasible in diverse high-risk infant follow-up clinics. The initiative was received positively by families and without adversely affecting clinic operational flow. Additional parent support and education are necessary.
Sections du résumé
BACKGROUND AND OBJECTIVES
Early diagnosis of cerebral palsy (CP) is critical in obtaining evidence-based interventions when plasticity is greatest. In 2017, international guidelines for early detection of CP were published on the basis of a systematic review of evidence. Our study aim was to reduce the age at CP diagnosis throughout a network of 5 diverse US high-risk infant follow-up programs through consistent implementation of these guidelines.
METHODS
The study leveraged plan-do-study-act and Lean methodologies. The primary outcome was age at CP diagnosis. Data were acquired during the corresponding 9-month baseline and quarterly throughout study. Balancing measures were clinic no-show rates and parent perception of the diagnosis visit. Clinic teams conducted strengths, weaknesses, opportunities, and threats analyses, process flow evaluations, standardized assessments training, and parent questionnaires. Performance of a 3- to 4-month clinic visit was a critical process step because it included a Hammersmith Infant Neurologic Examination, a General Movements Assessment, and standardized assessments of motor function.
RESULTS
The age at CP diagnosis decreased from a weighted average of 19.5 (95% confidence interval 16.2 to 22.8) to 9.5 months (95% confidence interval 4.5 to 14.6), with
CONCLUSIONS
Large-scale implementation of international guidelines for early detection of CP is feasible in diverse high-risk infant follow-up clinics. The initiative was received positively by families and without adversely affecting clinic operational flow. Additional parent support and education are necessary.
Identifiants
pubmed: 32269135
pii: peds.2019-2126
doi: 10.1542/peds.2019-2126
pmc: PMC7193973
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NICHD NIH HHS
ID : R01 HD081120
Pays : United States
Informations de copyright
Copyright © 2020 by the American Academy of Pediatrics.
Déclaration de conflit d'intérêts
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
Références
Dev Med Child Neurol. 2016 Mar;58(3):240-5
pubmed: 26306473
Pediatrics. 2017 Sep;140(3):
pubmed: 28860134
Phys Occup Ther Pediatr. 2003;23(3):7-29
pubmed: 14664309
J Pain Symptom Manage. 2005 May;29(5):489-97
pubmed: 15904751
Lancet. 1997 May 10;349(9062):1361-3
pubmed: 9149699
Child Care Health Dev. 2019 Nov;45(6):799-807
pubmed: 31323144
Dev Med Child Neurol Suppl. 2007 Feb;109:8-14
pubmed: 17370477
Dev Med Child Neurol. 2018 May;60(5):480-489
pubmed: 29468662
Ann Epidemiol. 2016 Mar;26(3):222-6
pubmed: 26851824
Pediatr Neurol. 2017 Nov;76:66-71
pubmed: 28982529
J Autism Dev Disord. 2019 May;49(5):1763-1777
pubmed: 30607783
Early Hum Dev. 2011 Sep;87(9):633-9
pubmed: 21616611
J Paediatr Child Health. 2000 Feb;36(1):32-5
pubmed: 10723688
J Child Neurol. 2016 Mar;31(3):364-9
pubmed: 26239493
Nat Rev Neurol. 2015 Apr;11(4):192-208
pubmed: 25686754
Dev Med Child Neurol. 2015 Jan;57(1):29-36
pubmed: 25041565
Dev Med Child Neurol. 2018 May;60(5):438
pubmed: 29517109
Pediatr Neurol. 2016 Dec;65:31-38
pubmed: 27765470
Clin Obstet Gynecol. 2008 Dec;51(4):749-62
pubmed: 18981800
Arch Dis Child. 2000 Dec;83(6):475-80
pubmed: 11087279
Pediatr Neurol. 2018 Oct;87:70-74
pubmed: 30190180
Dev Med Child Neurol. 2015 Oct;57(10):931-5
pubmed: 25855100
J Pediatr. 2018 Dec;203:156-162
pubmed: 30244983
Eur J Paediatr Neurol. 2013 Mar;17(2):192-8
pubmed: 23062755
Dev Med Child Neurol. 2014 Jan;56(1):59-65
pubmed: 24117446
JAMA Pediatr. 2017 Sep 1;171(9):897-907
pubmed: 28715518
Clin Perinatol. 1997 Sep;24(3):655-75
pubmed: 9394865
Dev Med Child Neurol. 2013 May;55(5):418-26
pubmed: 23574478
Early Hum Dev. 2005 Jul;81(7):623-7
pubmed: 15975743
Dev Disabil Res Rev. 2011;17(2):114-29
pubmed: 23362031