Guideline adherence in cystic fibrosis: a center-based analysis

Background: The Cystic Fibrosis Foundation (CFF) brings together committees of experts to write guidelines for various aspects of patient care. Despite these standardized guidelines, cystic fibrosis (CF) care centers and affiliates across the U.S. have been shown to have great variations in guideline adherence and patient outcomes. Methods: The 2012 center-level data for 114 centers and 49 affiliate programs was accessed online. This study described the variations in center-level patient outcomes and adherence to Clinical Care Practice Guidelines (Guidelines), defined as the proportion of patients with at least four outpatient visits, two pulmonary function tests, and one sputum culture annually. The outcome variables: forced expiratory volume in one second (FEV1) % predicted in adults, FEV1 % predicted in children, body mass index (BMI) in adults, and BMI percentile in children were case-mix adjusted for current age, race/ethnicity, age and presentation at diagnosis, pancreatic status, gender, and income based on the characteristics at the individual centers. Correlation coefficients were calculated to determine if center-level adherence to Guidelines is positively correlated with outcomes, and regression analysis was used to assess the ability of Guidelines adherence to predict outcomes. A model selection method evaluated if center-level covariates [proportion of patients screened for cystic fibrosis-related diabetes (CFRD), number of patients seen, and program type (center or affiliate)] improve the prediction of outcomes. Results: Guidelines adherence and FEV1 % predicted were significantly greater in children than adults (