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Cystic fibrosis clinical teams from the U.S. and Chile implement changes to improve outcomes for Chilean patients. This is the second of a two-part feature in Network News.
Published on June 13, 2018
In Chile, life expectancy overall approaches 80 years of age, but life expectancy for people with cystic fibrosis is around 20 years.
Dr. Hector Gutierrez, director of the pediatric CF center at the Children's Hospital/University of Alabama at Birmingham (UAB), suspected that this disparity could be reduced by applying a multidisciplinary approach with a focus on quality improvement.
In 2014, Gutierrez, Cathy Mims, R.N., B.S.N., and their team began working with clinicians from San Borja Arriaran Hospital in Santiago, Chile (described in the first part of this article).
After identifying how the approach to CF care differed between San Borja and the U.S., the UAB team shared guideline-based CF care delivery practices and exchanged visits with the Chilean team. The Chileans were struck by the U.S.'s team-based approach
-- a contrast to Chile where traditionally, the doctor has been the sole decision-maker. Watching the UAB team helped the San Borja team and the pulmonologist, Dr. Maria Lina Boza, realize the benefits of working less hierarchically.
By sharing their outcome data over time with the San Borja team, the UAB team illustrated its commitment to quality improvement processes. For example, the UAB team members discussed how they improved body mass index (BMI) over time, which underscored
the value that each team member, such as the dietitian, provides by seeing patients during each clinic visit. By sharing data and processes, the San Borja team witnessed how the UAB team was able to improve outcomes.
The team at San Borja implemented changes, including:
The education and training that the San Borja team and their patients received began to pay off.
After nine months of interventions, the team found that people with CF who performed CPT at home were able to improve their forced expiratory volume (FEV1), and exposure to clinical pathogens decreased. In addition, they were able to increase
enzyme dosing, caloric intake, and prescribed nutritional supplements to all children. During that time period, the weight-for-height percentile for children younger than 2 improved, as did BMI percentiles.
The work continues. The team from San Borja began to share what they have learned from UAB with other centers in Chile, including Padre Hurtado Hospital and San Juan de Dios Hospital, both in Santiago. The UAB team planned a visit to Chile in April where
they worked with four local CF teams, for which the San Borja team served as a mentor -- a clear indication that the seeds of change are taking root.
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