Changes in CF care during a pandemic: A reworking of workflow processes during unprecedented times

Background: Optimizing the nutritional health of pediatric CF patients has an enormous impact on lung function and development with dramatic repercussions on quality of life, life expectancy, and avoidable hospitalizations CF Foundation guidelines recommend that children with CF should have weight for length (W/L) or body mass index (BMI) > 50th percentile (%ile) Maintaining W/L or BMI > 50th %ile maximizes lung growth and optimizes lung function later in life We previously created a standardized pathway for patients to improve W/L and BMI %iles leveraging evidencebased literature The focus of this abstract is on our center's ability during the COVID-19 pandemic and resultant shift to primarily virtual visits to modify our pathway to maintain nutritional health Objective: A quality improvement project was initiated to develop methods to obtain accurate W/L and BMI %ile measurements to determine nutritional risk during the pandemic Key objectives: 1) Secure working scales for home use for patients with nutritional challenges;2) Engage caregivers to report appropriate weights and heights;3) Develop methods to accurately calculate W/L and BMI Methodology: BMI and W/L were calculated via the following methods: 1) If families had a working scale at home, we used it to measure weight;2) Children who did not have a scale and were deemed nutritionally at risk were offered a scale purchased with grant funding;3) Those not nutritionally at risk received a scale purchased through a DME company funded by North Carolina Medicaid;4) Those without scales at home and not nutritionally at risk were not included Heights (or lengths) were obtained in 1 of 3 ways: 1) height measured by family;2) assumed accurate height at last in-person visit if obtained within last month (mo);or 3) if > 1 mo since last visit, heights were calculated based on assumed normal linear growth from last measured in-person height %ile Results: 50 out 76 patients had a scale at the time of the virtual visit during the period 3/27/20 to 5/22/20 Scales were obtained through grants (n=20), Medicaid payer (n=16), Healthwell grants (n=1), families already had scales (n=39) Heights fell in these categories: 1) height measured by family (n=2);2) assumed accurate height at last visit if obtained within last mo (n=4);or 3) calculated heights based on assumed normal linear growth from last measured in-person height %ile (n=44) Weight calculations fell into 2 groups: Assumed accurate weight taken from EHR in last 2 weeks (n=1);Weight taken on home scale (n=49) At the virtual visit, 74% of patients (n=37) had demonstrated at least normal weight gain for 10 years and younger;patients greater than 10 years had a weight for age % within minus 5 %ile since last visit Preliminary results of 10 patients returning for in-person visits showed 60% (n=6) normal weight gain Conclusions: Having a methodology to support caregivers obtaining reliable W/L and BMI is crucial to maintain nutrition health during the pandemic Having consistent methods to obtain these measurements may help families who need more frequent visits to maintain nutrition health and help families engage in care Over the next few months, as some patients return for in-person visits, we plan to assess the accuracy of our methods to measure home W/L and BMI