Explanatory Sequential Mixed-Methods Study of the Effectiveness of the Childhood Dysphagia Management Scale (CDMS): Part 2 of a CDMS Hybrid Effectiveness-Implementation Study.

PURPOSE: As Part 2 of a Type 1 hybrid effectiveness-implementation study, we evaluated the effectiveness of the Childhood Dysphagia Management Scale (CDMS), a validated pediatric dysphagia outcomes assessment completed by therapists following instrumental swallow assessments.

METHOD: Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance and Consolidated Framework for Implementation Research implementation science frameworks, mixed methods were used to evaluate CDMS effectiveness in a tertiary care children's hospital system across the following areas: general/workflow, referrals, follow-up care, communication, and patient/caregiver impact. Using an explanatory sequential design, quantitative results informed qualitative interview guides. Referrals for and receipt of dysphagia management follow-up care were evaluated for patients seen pre-CDMS implementation (n = 533) and post-CDMS implementation (n = 594). Separate analyses were conducted for patients with Down syndrome. Results were modeled via ordinal logistic regression across patient-level and contextual factors. Surveys and interviews were conducted with referring providers (n = 17) and therapists (n = 35) to explore knowledge gaps revealed in the quantitative analysis. Qualitative data were analyzed using rapid qualitative analysis and integrated with quantitative data.

RESULTS

Pre- to post-CDMS implementation, referrals (28.7%-73.6%, p < .001) and receipt of follow-up care (57%-63%, p = .067) increased. Patients had 9.8 (7.31-13.29) times greater odds of referrals matching their CDMS score post-implementation (p < .001). Patients with Down syndrome had higher CDMS scores and follow-up care needs. Interviews revealed critical insights about mechanisms involved in the CDMS workflow that supported the observed improvements in referrals and follow-up care and also brought areas of challenge for dysphagia management care to light such as access, process dissemination, risk for service duplication, and family burden.

CONCLUSIONS

Implementing the CDMS and its associated workflow in a large children's hospital system provided an objective process that increased frequency of referrals and improved follow-up care for dysphagia management. Qualitative inquiry illuminated mechanisms, barriers, and facilitators.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.33180143.