Home spirometry utilisation in telemedicine clinic for cystic fibrosis care during COVID-19 pandemic: a quality improvement process

[摘要] Introduction The Cystic Fibrosis (CF) Foundationchronic care guidelines recommend monitoringspirometry during quarterly multidisciplinary visits toidentify early lung function decline. During the COVID-19pandemic, the CF adult clinic at University of Virginia(UVA) transitioned from the classic CF care modelto a model that included quarterly multidisciplinarytelemedicine visits. While using telemedicine, CF careneeded to include spirometry monitoring. Only a fractionof adult CF patients at UVA owned and used homespirometers (HS) in March 2020.Aim The specific aims of this quality improvement (QI)project were to increase the percentage of eligible adultCF patients who owned an HSs from 37% to 85% and toincrease the percentage of adult CF patients seen at UVAwith available spirometry in telemedicine from 50% to95% by 31 December 2020.Methods Following the Model for Improvement QImethodology, a standardised process was developed formonitoring forced expiratory volume in 1 s with HS duringmultidisciplinary telemedicine visits during the COVID-19pandemic.Intervention (1) HSs were distributed to eligible patientsand (2) Home spirometry was monitored in eligible patientswith each telemedicine visit and results were used forclinical care decisions.Results Both specific aims were achieved ahead ofexpected date. In March 2020, the beginning of thepandemic, 37% (49/131) of patients owned an HS and50% (9/18) of patients seen via telemedicine performedspirometry at home. By September 2020, 97% (127/131)of adult patients at UVA owned an HS and by October2020, 96% (24/25) of patients provided spirometry resultsduring their telemedicine encounters.Conclusion Employing QI tools to standardise theprocess of monitoring spirometry data with home devicesvia telemedicine is reliable and sustainable and can bereplicated across centres that provide care for patientswith CF.

[学科分类] 药学

[关键词] Quality improvement;COVID-19;Failure Modes and Effects Analysis (FMEA)