Untreated congenital hypothyroidism due to loss to follow-up: developing preventive strategies through quality improvement
-
Kristal Anne Matlock
,
Sarah Dawn Corathers
Abstract
Background
Children with congenital hypothyroidism (CH) are at risk for preventable intellectual disability without adequate medical management. The purpose of this manuscript is to discuss quality improvement (QI)-based processes for improving provider adherence to practice guidelines and ultimately identifying at-risk patients with chronic illness prior to the occurrence of adverse events.
Methods
Our study population included patients ages ≤3 years diagnosed with CH; lost to follow-up was defined as >180 days since last evaluation by an endocrinology provider. Iterative testing of interventions focused on establishing standardized care through (1) registry-based identification, (2) scheduling future appointments during current visits, (3) outreach to patients lost to follow-up and (4) provider and family education of current practice guidelines.
Results
A population-validated, electronic medical registry identified approximately 100 patients ages ≤3 years diagnosed with CH; initially, 12% of patients met criteria for lost to follow-up. Through serial testing of interventions, the rate of loss to follow-up declined to the goal of <5% within 8 months. Additional measures showed improvement in provider adherence to standard of care. All patients identified as lost to follow-up initially were seen within the first 3 months of intervention.
Conclusions
Applying QI methodology, a multidisciplinary team implemented a process to identify and contact high-risk CH patients with inadequate follow-up. Focused interventions targeting population management, scheduling and patient/provider education yield sustained improvement in the percentage of patients with a chronic condition who are lost to follow-up.
Acknowledgments
The authors would like to thank the patients, families and staff at Cincinnati Children’s Hospital Medical Center. The authors also acknowledge the multidisciplinary QI team members who were integral to improvements in patient care: Christopher Alexander, Michelle Biery, Sarah Boyd, Madeline Campbell, Samantha Ellsworth, Sherry Elmore, Farida Mostajabi and Ann Planicka.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
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Articles in the same Issue
- Frontmatter
- Original Articles
- Intracranial pathologies associated with central diabetes insipidus in infants
- Omentin-1 and NAMPT serum concentrations are higher and CK-18 levels are lower in children and adolescents with type 1 diabetes when compared to healthy age, sex and BMI matched controls
- Evaluation of anthropometric parameters of central obesity in Pakistani children aged 5–12 years, using receiver operating characteristic (ROC) analysis
- A lower energetic, protein and uncooked cornstarch intake is associated with a more severe outcome in glycogen storage disease type III: an observational study of 50 patients
- Untreated congenital hypothyroidism due to loss to follow-up: developing preventive strategies through quality improvement
- The effect of 17 years of increased salt iodization on the prevalence and nature of goiter in Croatian schoolchildren
- Is there an association between thyrotropin levels within the normal range and birth growth parameters in full-term newborns?
- Etiology of short stature in Indian children and an assessment of the growth hormone-insulin-like growth factor axis in children with idiopathic short stature
- Growth of patients with congenital adrenal hyperplasia due to 21-hydroxylase in infancy, glucocorticoid requirement and the role of mineralocorticoid therapy
- A personal series of 100 children operated for Cushing’s disease (CD): optimizing minimally invasive diagnosis and transnasal surgery to achieve nearly 100% remission including reoperations
- 12-Week aerobic exercise and nutritional program minimized the presence of the 64Arg allele on insulin resistance
- Letter to the Editor
- Successful treatment of life-threatening severe metabolic acidosis by continuous veno-venous hemodialysis in a child with diabetic ketoacidosis
- Case Reports
- Two siblings with metachromatic leukodystrophy caused by a novel identified homozygous mutation in the ARSA gene
- To diet or not to diet in neonatal diabetes responding to sulfonylurea treatment
- Van Wyk-Grumbach syndrome with hemangioma in an infant
- Maternal iodine excess: an uncommon cause of acquired neonatal hypothyroidism
