Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Division of Pulmonary Medicine, Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
BMJ Open Qual. 2020 Jul;9(3). doi: 10.1136/bmjoq-2019-000890.
Cystic fibrosis (CF) is known to reduce lung function as measured by per cent predicted for the forced expiratory volume in the first second (ppFEV) over time. Our paediatric CF programme demonstrated significant gaps in benchmarked ppFEV predicted compared with the national median. Our objective was to assess whether the implementation of a modified e-ducation of irway learance echniques (REACT) programme could lead to an improvement in lung function as measured by ppFEV.
This 2-year prospective quality improvement study at Lurie Children's CF Center for children aged >6 years used improvement methodology to implement a modified REACT programme. Outcome measures were assessed for our entire programme via the CF Foundation Patient Registry (CFFPR) and statistical process control. Comparisons were also made before and after REACT for outcome measures.
By the end of implementation, monthly participation rate achieved 100%. Using CFFPR data and SPC, median ppFEV increased by 3.9%, whereas only body mass index (BMI) as a secondary outcome increased. Comparison of pre and post REACT showed improvements in average ppFEV (95% vs 96%, p<0.0001), FEF (82% vs 83%, p=0.0590), rate of ppFEV1 decline (+2% vs -4%, p=0.0262) and BMI percentile (57% vs 60%, p<0.0001).
Implementation of a modified REACT at Lurie Children's paediatric CF programme led to an increase in ppFEV, FEF and BMI percentile.
囊性纤维化（CF）会导致第一秒用力呼气量（FEV1）占预计值的百分比（ppFEV）随时间逐渐下降，进而导致肺功能降低。我院儿科 CF 项目的 ppFEV 预测值与全国中位数相比存在显著差距。本研究旨在评估改良后的气道廓清技术教育（REACT）项目实施后，ppFEV 能否改善肺功能。
这项为期 2 年的前瞻性质量改进研究在 Lurie 儿童医院 CF 中心进行，研究对象为年龄＞6 岁的儿童。我们采用改进方法实施改良的 REACT 项目。通过 CF 基金会患者注册系统（CFFPR）和统计过程控制来评估整个项目的结果指标。还对 REACT 前后的结果指标进行了比较。
实施结束时，每月参与率达到 100%。使用 CFFPR 数据和 SPC，ppFEV 中位数增加了 3.9%，而只有 BMI 作为次要结果增加。REACT 前后的比较显示，ppFEV 平均值（95% vs 96%，p＜0.0001）、FEF（82% vs 83%，p=0.0590）、ppFEV1 下降率（+2% vs -4%，p=0.0262）和 BMI 百分位数（57% vs 60%，p＜0.0001）均有改善。
在 Lurie 儿童医院儿科 CF 项目中实施改良的 REACT 可提高 ppFEV、FEF 和 BMI 百分位数。
