Carry Patrick M, Graham Susan, Whalen Karen, Burke Deborah, Baschal Robin, Holmes Kaley S, Kohuth Brian, Georgopoulos Gaia, Miller Nancy Hadley
Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colo.
Department of Orthopedics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo.
Pediatr Qual Saf. 2020 Oct 23;5(6):e362. doi: 10.1097/pq9.0000000000000362. eCollection 2020 Nov-Dec.
Clubfoot describes a congenital condition. If untreated, clubfoot can cause long-term functional issues. The Ponseti method is the gold-standard treatment; it emphasizes casting over surgery. We identified a high rate of major recurrence in patients with isolated clubfoot at our institution. We implemented a quality improvement intervention to address the recurrences.
We established a clubfoot program that aimed to (1) develop a standardized treatment pathway; (2) improve care team education; (3) improve coordination of care with families; and (4) improve documentation. The purpose of this study was to outline our quality improvement intervention and evaluate its success. Data were retrospectively collected from isolated clubfeet before (2003-2007, phase I) and after (2012-2014, phase II) implementation of the clubfoot program. We compared the differences in treatment and major recurrence between the 2 phases using generalized logistic or linear mixed models. Modified Poisson regression models were used to evaluate the association between provider nonadherence and recurrence.
The pre- (phase I) and post- (phase II) implementation groups included 91 patients (131 feet) and 68 patients (101 feet), respectively. The incidence of major recurrence (odds ratio: 59.5, 95% confidence interval: 7.8-454.4, < 0.0001) was lower during phase II compared to phase I. Nonadherence with the care pathway was associated with an increased risk of recurrence (risk ratio: 4.1, 95% confidence interval: 1.2-14.3, = 0.0274).
The implementation of a clubfoot program was associated with a decrease in major clubfoot surgery and improved adherence to established guidelines for clubfoot management.
马蹄内翻足是一种先天性疾病。若不治疗，马蹄内翻足可导致长期功能问题。庞塞蒂方法是金标准治疗方法；它强调石膏固定而非手术治疗。我们发现本机构孤立性马蹄内翻足患者的主要复发率很高。我们实施了一项质量改进干预措施来解决复发问题。
我们建立了一个马蹄内翻足项目，旨在（1）制定标准化治疗路径；（2）加强护理团队教育；（3）改善与家庭的护理协调；（4）完善记录。本研究的目的是概述我们的质量改进干预措施并评估其成效。回顾性收集了马蹄内翻足项目实施前（2003 - 2007年，第一阶段）和实施后（2012 - 2014年，第二阶段）孤立性马蹄内翻足患者的数据。我们使用广义逻辑或线性混合模型比较了两个阶段在治疗和主要复发方面的差异。采用修正泊松回归模型评估医疗服务提供者不依从与复发之间的关联。
实施前（第一阶段）和实施后（第二阶段）的两组分别包括91例患者（131只脚）和68例患者（101只脚）。与第一阶段相比，第二阶段主要复发的发生率较低（优势比：59.5，95%置信区间：7.8 - 454.4，<0.0001）。护理路径不依从与复发风险增加相关（风险比：4.1，95%置信区间：1.2 - 14.3，P = 0.0274）。
马蹄内翻足项目的实施与主要马蹄内翻足手术的减少以及对既定马蹄内翻足管理指南依从性的提高相关。
