Assessing Adherence to Audiologic Parameters of Care for Children With Cleft Palate: A Quality Improvement Initiative.

OBJECTIVE

To evaluate and increase adherence to an evidence-based audiologic management protocol for children with cleft palate.

DESIGN

Prospective, multidisciplinary quality improvement initiative.

SETTING

Tertiary pediatric hospital.

PATIENTS,

PARTICIPANTS

Children with cleft palate (with or without cleft lip) between the ages of 0 and 5 years (n = 205).

INTERVENTIONS: A multidisciplinary team identified key drivers for nonadherence to recommended audiological follow-up and implemented interventions to improve adherence. Key drivers included provider practices and preferences, clinic logistics and flow, and patient/family awareness and education. Several interventions were implemented between 2016 and 2020, including developing an evidence-based audiologic protocol, maximizing access to audiologic clinic visits across multiple departments, cleft team education, and improved team communication.

MAIN OUTCOME MEASURE(S): Completion of recommended audiologic assessment at 5 separate care milestones.

RESULTS

After implementation of interventions between 2016 and 2020, adherence to recommended audiologic follow-up increased from 59% to 84%. Analysis of individual care milestones revealed that increased access to audiologic testing during team clinics resulted in the largest increase in adherence to recommended follow-up. Additionally, cause-effect analysis revealed that nonadherence due to provider-related causes decreased over the project period to a greater extent than patient/family-related causes.

CONCLUSIONS

Implementation of an evidence-based audiologic care protocol and improvements in access to early hearing care are feasible in a high-volume multidisciplinary cleft clinic. Adherence to recommended audiologic management can be improved by establishing strategies to improve access to care, team member and family education, and enhanced team communication.