a specialist’s story: my path to a mature quality improvement program ana cairns d.o. f.a.c.p....

A Specialists Story: My Path to a Mature Quality Improvement ProgramAna Cairns D.O. F.A.C.P.Associate Professor of Pediatrics, MMC Cystic Fibrosis Center Director

How did QI come to the CF Community?CF Foundation Registry Northern N. England Consortium 1996Seeking to improve CF care in N. New EnglandPuzzled by variation in care and outcomes at different centersUn-blinding the data allow us to learn from each other

The Opportunity Statement2002: We believe that the life expectancy of CF patients can be extended through the consistent implementation of existing evidence-based clinical care. CF Foundation2003: Learning and Leadership CollaborativeQI training across 120 CF centers

Reactions to outcome dataThe data are wrongThe data are right, but its not a problemThe data are right, it is a problem, but its not my problem.I accept the burden of improvement

Institute of Medicine recommendations for the redesign of health careThe health care system should make information available to patients and their families that allows them to make informed decisions..this should include information describing the systems performance on safety, evidence-based practice and patient satisfaction

QI and the CF Community2006: transparency of CF Registry at www.cff.orgCF Foundations Vision: exemplary care at all CF centersUltimate goal: prolonging median survival in CF patients by 10 years

Involving families in improving care: CF Patient Advisory Council: Goals:making care truly responsive to the needs and goals of familiesto strive to improve the care delivered at CF centersoutcomes cannot improve without the input and participation of families2006: MMC CF Patient Advisory Council formed

Team workEssential part of CF modelAdult and pediatric multidisciplinary Team: MD, RN, RT, LSW, PT, Pharm D, MA, CNP, RDEffective and frequent meetings to evaluate QI projects are essentialBuy in and ownership by the whole team is important

Picking your QI projectStart simple-success is rewardingPick projects with clear outcomes and goals that can be measured effectivelyComplex QI may take time to see change, be patient!

ChartingCharting your process and displaying results critical to successSeveral methods: Fishbone diagrams: explore and display sources of opinion about variationFlow charts, Value stream mapping: pictorial representation of steps in a given processRun charts: to display data over time-posted in clinic to monitor progress

Influences on Nutritional SuccessPsychosocialFamily involvementEducationS.E.S.EmploymentTransportationHealthcare SystemMotivationCF CenterEducationAllocation of funds and resourcesAdministrationTeamworkAwarenessFundingInsurancePharmacy assistance programs

Alternative funding Vocational trainingFamily financesCommunicationCF CentersPatientLLC IIAdministrationUAB/CHS CF TeamPatients familyPatientIllness/ComorbidityAppropriate enzyme useDepressionMalabsorptionSteroidsCFRDLung DiseasePainLiver diseaseDenialEducationMotivationSubstance AbuseEating habitsKnowledgeBehaviorDepression

Adult CF clinic flow chart

Value Stream MappingChart ReviewCategorization of patients and port CF print outsCF Care Conference

Nurses inform registration of ordersRegistration/Update patient informationLab x-ray -Family responsible for bringing film to clinicTriage,Ht. Wt. VSWaiting roomClinic roomPatient in clinic room/Sputum obtainedInterview/history

Plan made and discussed with patient and familyFollow up plan and appointmentDocumentation

PFTsUAGrowth percentiles completed by nurse or MDWalk through comments 1. Too much waste in employee work habits (I,e, laughter and discussions in clinic area) 2. Duplication of medication history 3. No one asked about smoke exposure 4. More in depth information about family changes

Run charts

Chart1

52.153510977

61.7021276596

63.6363636364

70.4545454545

2009 Q4

Sheet1

Oral Supplements Monthly Run-Chart

QueryQuery

MonthPatients

Benchmarking: best practice sitesLooking at processes within a practice for minor improvements that effect changePairing groups by discipline to identify ideas -have MAs talk to MAs, RN to RNBringing home themes and attributes of other practices to shareShare QI methods and steal shamelessly

Improving the CF inpatient hospitalizationGoal: develop an CF inpatient nurse collaborative to improve CF inpatient care and the hospital experience for familiesMethods:Patient surveys target key areas of educationPatient satisfaction surveys done over 12 monthsAll day CF Skills Fair for staffSchedule boards in rooms

Staff Skills Fair Follow-up Survey n-30

Increase in comfort level caring for CF patientsHelpful in family educationHow likely are you to review infection control policyAttend another CF skills Fair

Family Surveys % change in practice

Use of schedule boardsAdmission info packetsAdherence to Schedule Review of infection control policy

Chart1

60

68

70

65

75

75

80

85

87

85

% of patients who reported satisfactory hospital experience2006-2008

XmR Template 1 chart

XmR Control Chart TemplatePrint set-up is set for printing the charts only. (Page set-up horizontal, 100% reduction) (Can change to print A13:S53, horizontal, 60% reduction to also include data columns.)

DEFINITIONS

Do These Steps FirstX Mean =75.00average of all the x's =AVERAGE(B16:B51)

Revise/Enter appropriate datesUCLnp =86.53X Mean + (R Mean * 2.66)

in column ALCLnp =63.47X Mean - (R Mean * 2.66)

(can use Fill -> Down -> Series)R Mean =4.33average of the moving range (mR) values = AVERAGE(C17:C51)

Enter data values in Data column BUCLmr =14.17R Mean * 3.27

Only need to enter dataMoving Range = | x2 - x1| = ABS(B17-B16)Do These Steps Second

in "yellow" cells. Open up the top chart (click on the chart)

Save file under a new name to preserve the original template Change the Title and the Y Axis label (click/select those titles, type in new appropriate text to identify your data)

Change the vertical scale if desired (double click on the vertical axis, select Scale tab)

Change the format of the numbers on the vertical scale by changing the format of the data column B

XmRPrinting

MovingLimits for the X ChartsLimits for mR chart Click on the top chart - remember you can change the font to be larger, or bold

DateDataRangeUCLnpX MeanLCLnpUCLmrR Mean Change header and footer to date and title your file -> Print Preview -> Setup -> Header/Footer tab

Oct-026086.5375.0063.4714.174.33 Print if you like what you see.

Jan-03688.0086.5375.0063.4714.174.33

Apr-03702.0086.5375.0063.4714.174.33

Jul-03655.0086.5375.0063.4714.174.33

Oct-037510.0086.5375.0063.4714.174.33

Apr-03750.0086.5375.0063.4714.174.33

Jul-03805.0086.5375.0063.4714.174.33

Sep-03855.0086.5375.0063.4714.174.33

Dec-03872.0086.5375.0063.4714.174.33

Apr-04852.0086.5375.0063.4714.174.33

CHARTS DO NOT PLOT BEYOND THIS LINE.

YOU NEED TO EXTEND SERIES RANGE IN THE CHART TO INCLUDE ADDITIONAL POINTS

END OF FORMULAE

&L&"Helvetica"&6&D &F&C&"Helvetica"All data points were used to calculate the means and the limits.


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Overall Satisfaction

Chart1

60

68

70

65

75

75

80

85

87

85

% of patients who reported satisfactory hospital experience2006-2008


XmR Control Chart TemplatePrint set-up is set for printing the charts only. (Page set-up horizontal, 100% reduction) (Can change to print A13:S53, horizontal, 60% reduction to also include data columns.)

DEFINITIONS

Do These Steps FirstX Mean =75.00average of all the x's =AVERAGE(B16:B51)

Revise/Enter appropriate datesUCLnp =86.53X Mean + (R Mean * 2.66)

in column ALCLnp =63.47X Mean - (R Mean * 2.66)

(can use Fill -> Down -> Series)R Mean =4.33average of the moving range (mR) values = AVERAGE(C17:C51)

Enter data values in Data column BUCLmr =14.17R Mean * 3.27

Only need to enter dataMoving Range = | x2 - x1| = ABS(B17-B16)Do These Steps Second

in "yellow" cells. Open up the top chart (click on the chart)

Save file under a new name to preserve the original template Change the Title and the Y Axis label (click/select those titles, type in new appropriate text to identify your data)

Change the vertical scale if desired (double click on the vertical axis, select Scale tab)

Change the format of the numbers on the vertical scale by changing the format of the data column B

XmRPrinting

MovingLimits for the X ChartsLimits for mR chart Click on the top chart - remember you can change the font to be larger, or bold

DateDataRangeUCLnpX MeanLCLnpUCLmrR Mean Change header and footer to date and title your file -> Print Preview -> Setup -> Header/Footer tab

Oct-026086.5375.0063.4714.174.33 Print if you like what you see.

Jan-03688.0086.5375.0063.4714.174.33

Apr-03702.0086.5375.0063.4714.174.33

Jul-03655.0086.5375.0063.4714.174.33

Oct-037510.0086.5375.0063.4714.174.33

Apr-03750.0086.5375.0063.4714.174.33

Jul-03805.0086.5375.0063.4714.174.33

Sep-03855.0086.5375.0063.4714.174.33

Dec-03872.0086.5375.0063.4714.174.33

Apr-04852.0086.5375.0063.4714.174.33

CHARTS DO NOT PLOT BEYOND THIS LINE.

YOU NEED TO EXTEND SERIES RANGE IN THE CHART TO INCLUDE ADDITIONAL POINTS

END OF FORMULAE

&L&"Helvetica"&6&D &F&C&"Helvetica"All data points were used to calculate the means and the limits.


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&F

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Units of Measure

Overall Satisfaction

Examples: CF Culture Based SchedulingGoal: Separating patients based on respiratory culture to limit possibility of cross infection in clinicCategorized into four groups:Green Pa negative MRSA negative Blue Pa growth Yellow MRSA Red B. cepacia

Pt List

PATIENT NAMEDOBGroupMRSAB.CepaciaPA+EPICAnnualLegendAppt times

Alger William11/21/05GreenGreenNo PA, MRSA, B. Cepacia8:15, 8:45

Anderson, Gabriella8/11/08GreenBluePA+9:30, 10:15

Anderson, Rachael5/30/94GreenXYellowMRSA+11:00, 11:30

Auclair, Joseph1/21/91Red2006RedB.Cepacia11:00, 11:30

Benner, Melayna11/27/00Yellow20082003X

Bernard, Bethany10/3/91Blue2006Appointments per clinic

Biasuz, Gabriel7/30/04Green2006All 45 minute appointments

Blair, Sara6/9/98Blue20088:153 Green appointments

Blanche, Carter7/29/07Green8:453 Green appointments

Boisvert, Damien6/22/04Yellow9:303 Blue appointments

Bolduc, Miroslav6/10/88Red2006200710:153 Blue appointments

Bourgois, Sean8/16/89Yellow2008200811:00

Bowman, Zachary8/30/05Green2006X11:30

Brann, Allison2/25/00Blue2008

Brauer, Beatrice6/21/96

Bridges, Christopher5/14/96Blue2005

Brown, Sydney12/20/98Yellow20082005

Bryant, Ezekiel10/20/00Red20082008X

Bumford, Michaela2/25/97Blue2007

Burgess, Aaron3/28/91Green

Bushman, Levi12/6/01Yellow20072008

Campbell, Makenna11/22/05Blue2008X

Caswell Trinity8/18/05Green2005

Clifford, Benjamin2/14/89Blue2008

Cressey, Amaya3/14/07Green

Cousert, Megan7/5/90Yellow2007

Crowley, Owen8/6/02GreenX

Davidson, Piper6/2/04Blue2007

Dawson, Nicole6/9/05Blue2008X

Denis, Deon4/13/99Yellow20082008

Dondlinger, Emma9/3/08

Dondlinger, Zachary9/3/08

Dostie, Amber2/17/97Blue2008

Dubois, Rachael6/5/91Blue2006

Dubois, Richard4/24/89Blue2006

Ellis, Trenton7/19/02Green

Ewy, Emma3/24/95GreenXLegendAppt times

Farrar, Jarod7/20/01GreenXGreenNo PA, MRSA, B. Cepacia8:15, 8:45

Farrell, Erin6/19/05Yellow20062005BluePA+9:30, 10:15

Flagg, Caleb7/23/01GreenXYellowMRSA+11:00, 11:30

Flagg, Wyatt10/17/07Blue2008RedB.Cepacia11:00, 11:30

Flaherty Tyler7/11/95Green

Fowler, Cailyn1/5/95Red20052007Appointments per clinic

Freeman, Kayleb8/4/05Blue2007XAll 45 minute appointments

Gaffney, Kyla12/27/06Green8:153 Green appointments

Gallant, Trevor12/21/97Green8:453 Green appointments

Garey, Austin12/27/05GreenX9:303 Blue appointments

Gay, Jerrica5/20/91Blue200810:153 Blue appointments

Gay, Marki1/14/90Blue200411:00

Gerow, Rachel12/15/97Blue2003X11:30

Gilblair, Edward3/14/92Yellow20082008

Gosselin-Brown11/21/05Blue2004

Hassan, Nabilah10/14/07

Holteen, Malcolm1/14/94Yellow2004

Hotham, Alexander11/7/96Red200620062005

Hunnewell, Abigail11/27/98Yellow20082000X

Jalbert, Ethan12/16/99Blue2002X

Johnson, Cameron9/14/97Green

Larochelle, Kristen3/16/90Blue2005

Larue, Amanda7/31/91Green

Lemont, Ayisha5/20/07Green

Madore, Novalee5/1/07Green

Marshall, Kate6/13/99Blue2008X

Martin, Taylor3/7/97Yellow20082003X

Merchant, Ashley12/7/97Yellow20082003

Messier, Shea5/6/96Blue2008

Mitchell, Abbey2/14/96Blue2007

Moriarty,Sean7/1/02Blue2008

Myers, Leilani1/25/06Green

Naher, Anika5/13/96

O'Connor, Brian6/29/92Yellow20072005

Ouellette, Sarah2/10/94Blue2007

Overlock, Jarod8/4/98Green1999X

Pettingil, Adrianna8/18/08

Pettingil, Blake8/7/06Green

Pilotte, Amber2/16/93GreenX

Pendexter, Michael9/16/96Blue2008

Reed, Hogan9/15/96Yellow20082004

Reynolds, Nicole1/15/95Blue2008

Roach, Vanessa8/2/91Green

Rogers, Eli4/14/04Blue2008X

Schulberg, Bethany11/23/94Blue2008X

Slocum, Jacob12/5/07Green

Slocum, Tyler11/1/05GreenX

Storey, Hannah4/10/00Blue2006X

Thiboutot, Aaron8/2/93Yellow20082008

Thiele, William10/4/06Green

Tompkins, Mackenzie3/10/02Blue2004

Wales, Paige11/18/00Yellow2008

Warner, Edward7/16/08

&R&8&D

&R&8&Z&F

Protocol

in the clinic setting

Summary:Patients are grouped into one of four pathogen catagories:

GreenNo PA, MRSA, B. Cepacia

BluePA+

YellowMRSA+

RedB.Cepacia

Patients are assigned clinic times based on category:

8:152 Green appointments

8:452 Green appointments

9:303 Blue appointments

10:153 Blue appointments

11:00

11:30

*Cultures are updated after each clinic visit and the patient is recatagorized as needed.

*The CF nurses contact the family if a category change has occurred and update the spreadsheet

*Catagories are also in the scheduling program to alert schedulers to

each patient's assigned clinic time

*Patients who do not grown PA or MRSA for two years are moved to green appointments

*Patients who have ever grown B Cepacia remain in the red category

*Rooms are all cleaned with antiseptic spray and wiped down after each patient

*Standard precautions remain in effect for all patients

*Contact precautions for all MRSA and B. Cepacia patients

*For patients who grown more than one of the stated pathogens: The patient is catagorized

by the latest pathogen.

ie: a patient who grows PA and MRSA will be seen in the yellow category

Sheet3

Newly acquired CF pathogens

Pulmonary QIGoal: diagnose and treat more pulmonary exacerbations to increase our median Fev1 over timePlan: phone triage sheet for nurses exacerbation assessment sheet for providers with pulmonary exacerbation scoreRT added to clinic

Antibiotic use for pulmonary exacerbations

Median FEV1 %

Improving NutritionBetter nutrition improves pulmonary outcomes and lengthens life expectancyGoal: improve the age specific median BMI % towards 55% Plan: more intensive interventions of patients with BMI

Q1: Jan-MarQ2: Jan-JunQ3: Jan-SepQ4: Jan-DecMedian BMI PercentileQuarterMedian BMI Percentile 2008-2009

Chart1

40.13

42.365

48.09

46.9

46.66

2009 Q4

Quarter

Median BMI

Median BMI 2009

Graph

BMI Run Chart

Median BMI

200740.1

200842.4

2009 Q148.1

2009 Q246.9

2009 Q346.7

2009 Q4

Graph

Quarter

Median BMI

Median BMI 2009

07BMI

First NameLast NameBirth DateCFFIDDate of Clinical VisitBMI Percentile

RACHELANDERSON5/30/941412943/14/0783.47

RACHELANDERSON5/30/941412946/27/0783.05

RACHELANDERSON5/30/941412949/26/0778.29

RACHELANDERSON5/30/9414129412/26/0785.16

josephauclair1/21/911328823/14/0737.33

josephauclair1/21/911328829/12/0723.37

josephauclair1/21/9113288210/1/0733.2

josephauclair1/21/9113288211/28/0730.67

MELAYNABENNER11/27/001447103/14/072

MELAYNABENNER11/27/001447105/9/072.6

MELAYNABENNER11/27/001447106/25/0734.38

MELAYNABENNER11/27/001447108/8/0717.8

MELAYNABENNER11/27/0014471011/14/0713.58

MELAYNABENNER11/27/0014471012/18/0726.51

BethanyBernard10/3/9114929110/10/0730.29

SARABLAIR6/9/981435772/28/0742.14

SARABLAIR6/9/981435776/27/0742.32

SARABLAIR6/9/981435779/12/0744.09

SARABLAIR6/9/9814357712/12/0736.19

MIROSLAVBOLDUC6/10/881006713/14/070.05

MIROSLAVBOLDUC6/10/881006715/16/070



MIROSLAVBOLDUC6/10/881006719/21/070.01

MIROSLAVBOLDUC6/10/8810067110/17/070.01

MIROSLAVBOLDUC6/10/8810067112/14/070.01

SEANBOURGEOIS8/16/891357741/24/0748

SEANBOURGEOIS8/16/891357744/25/0743.05

SEANBOURGEOIS8/16/891357747/25/0748.8

SEANBOURGEOIS8/16/8913577410/10/0745.24

SEANBOURGEOIS8/16/8913577412/26/0752.95

ZacharyBowman8/30/051533569/12/0762.17

ZacharyBowman8/30/0515335612/12/0770.18

ALLISONBRANN2/25/001459821/10/0797.51

ALLISONBRANN2/25/001459822/28/0796.85

ALLISONBRANN2/25/001459826/13/0796.35

ALLISONBRANN2/25/001459829/26/0795.24

CHRISTOPHERBRIDGES5/14/961402503/28/0713.52




AdrianaBrown7/5/971512031/24/0777.81

AdrianaBrown7/5/971512032/1/0777.21

AdrianaBrown7/5/971512033/14/0765.12

AdrianaBrown7/5/971512033/21/0765.12

AdrianaBrown7/5/971512035/25/0763.11

AdrianaBrown7/5/971512037/2/0767.75

AdrianaBrown7/5/971512039/12/0765.06

AdrianaBrown7/5/9715120312/12/0778.52

SYDNEYBROWN12/20/981447622/28/0727.78

SYDNEYBROWN12/20/981447625/23/0723.05

SYDNEYBROWN12/20/9814476212/26/0729

EZEKIELBRYANT10/20/001460021/10/0762.79

EZEKIELBRYANT10/20/001460024/11/0777.32

EZEKIELBRYANT10/20/001460026/15/0782.52

EZEKIELBRYANT10/20/0014600210/24/0774.29

MICHAELABUMFORD2/25/971414842/28/070.95




AARONBURGESS3/28/911330269/26/0768.92

AARONBURGESS3/28/9113302611/28/0773.27

LeviBushman12/6/011576335/22/072.84

LeviBushman12/6/011576337/3/0721.96

LeviBushman12/6/011576339/26/0718.98

LeviBushman12/6/0115763311/9/0735.37

MakennaCampbell11/22/0515384411/28/0721.06

HELENACARR12/18/971425277/11/0736.94

HELENACARR12/18/9714252712/12/0739.08

HELENACARR12/18/971425273/14/0754.82

TrinityCaswell8/18/0515341411/28/075.41

BENJAMINCLIFFORD2/14/891244143/28/0745.01





MeganCousert7/5/901336362/6/0772.84

MeganCousert7/5/901336363/6/0772.53

MeganCousert7/5/901336366/12/0776.15

MeganCousert7/5/901336366/28/0773.8

MeganCousert7/5/901336368/22/0778.62

MeganCousert7/5/9013363610/9/0774.31

MeganCousert7/5/9013363610/19/0777.41

MeganCousert7/5/9013363611/14/0776.88

MeganCousert7/5/9013363611/20/0777.91

OwenCrowley8/6/021472971/10/072.88

OwenCrowley8/6/021472976/13/071.33

OwenCrowley8/6/0214729710/24/073.77

OwenCrowley8/6/0214729712/7/071.75

CHRISTOPHERDAVENPORT4/20/971415122/28/0740.36



PiperDavidson6/2/041512023/14/070.56

PiperDavidson6/2/041512027/25/0715.03

PiperDavidson6/2/0415120210/22/0740.55

PiperDavidson6/2/0415120212/4/0748.54

NicoleDawson6/9/051531346/27/0790.69

NicoleDawson6/9/0515313410/24/0780.4

DEONDENIS4/13/991437344/11/0755.82

DEONDENIS4/13/991437347/11/0757.94

DEONDENIS4/13/991437347/23/0775.59

DEONDENIS4/13/9914373410/24/0767.17

AMBERDOSTIE2/17/971415521/30/0736.53

AMBERDOSTIE2/17/971415523/28/0720.21

AMBERDOSTIE2/17/971415525/2/0744.55

AMBERDOSTIE2/17/971415527/11/0727.37

AMBERDOSTIE2/17/971415527/16/0728.29

AMBERDOSTIE2/17/971415528/22/0734.65

AMBERDOSTIE2/17/9714155210/12/0723.05

RachaelDubois6/5/911514551/10/0763.88

RachaelDubois6/5/911514551/16/0763.88

RachaelDubois6/5/911514552/28/0768.31

RachaelDubois6/5/911514555/23/0769.34

RachaelDubois6/5/9115145511/20/0767.96

RichardDubois4/24/891399203/26/0779.28

RichardDubois4/24/8913992011/14/0784.26

trentonellis7/19/021487706/13/0742.9

trentonellis7/19/021487703/14/0736.44

trentonellis7/19/0214877011/14/0758.49

EMMAEWY3/24/951415822/28/0744.67

EMMAEWY3/24/951415825/23/0749.82

EMMAEWY3/24/951415827/25/0752.25

EMMAEWY3/24/9514158210/10/0760.62

JarodFarrar7/20/981437991/22/0777.79

JarodFarrar7/20/981437993/14/0784.16

JarodFarrar7/20/981437993/27/0780.87

JarodFarrar7/20/981437995/9/0783.06

JarodFarrar7/20/981437997/25/0771.44

JarodFarrar7/20/9814379910/24/0772.06

erinfarrell6/19/051534167/25/0714.65

erinfarrell6/19/0515341610/10/0716

CalebFlagg7/23/011474071/9/0786.8

CalebFlagg7/23/011474077/11/0786.55

CalebFlagg7/23/0114740711/28/0771.21

TylerFlaherty7/11/951404374/27/0716.7

TylerFlaherty7/11/951404374/9/070.52

TylerFlaherty7/11/951404375/25/0711.7

TylerFlaherty7/11/951404376/13/0720.95

TylerFlaherty7/11/9514043710/10/078.59

CAILYNFOWLER1/5/951392121/10/0732.13

CAILYNFOWLER1/5/951392121/22/0727.95

CAILYNFOWLER1/5/951392121/26/0727.18

CAILYNFOWLER1/5/951392122/28/0735.44

CAILYNFOWLER1/5/951392124/25/0750.95

CAILYNFOWLER1/5/951392128/8/0737.6

CAILYNFOWLER1/5/9513921210/3/0763.81

CAILYNFOWLER1/5/9513921211/14/0736.4

KaylebFreeman8/4/051540659/12/0792.14

KaylebFreeman8/4/0515406512/12/0791.77

TrevorGallant12/21/971572147/11/0746.82

TrevorGallant12/21/9715721410/10/0747.95

AustinGarey12/27/041526173/14/0767.52

AustinGarey12/27/041526175/9/0774.94

AustinGarey12/27/041526178/22/0781.56

AustinGarey12/27/0415261711/14/0778.2

JERRICAGAY5/20/911367805/9/0781.13

JERRICAGAY5/20/911367808/8/0786.25

JERRICAGAY5/20/9113678010/24/0787.39

JERRICAGAY5/20/911367801/24/0787.6

RACHAELGEROW12/15/971462653/28/0751.86

RACHAELGEROW12/15/971462656/18/0749.88

RACHAELGEROW12/15/9714626511/28/0748.35

EDWARDGILBLAIR3/14/921351711/10/070.56

EDWARDGILBLAIR3/14/921351711/30/070.56

EDWARDGILBLAIR3/14/921351715/9/070.25

EDWARDGILBLAIR3/14/921351716/27/070.02

EDWARDGILBLAIR3/14/921351718/8/070.4

EDWARDGILBLAIR3/14/9213517110/24/071.54

EDWARDGILBLAIR3/14/9213517111/7/072.17

EDWARDGILBLAIR3/14/9213517112/26/070.65

ALEXANDERHOTHAM11/7/961417521/9/073.36








ABIGAILHUNNEWELL11/27/981439754/11/0757.11





ETHANJALBERT12/16/991439992/28/0795.68

ETHANJALBERT12/16/991439996/27/0789.64

ETHANJALBERT12/16/991439999/26/0792.58

KRISTENLAROCHELLE3/16/901006672/21/0749.22









AmandaLarue7/23/911330272/27/0721.4

AmandaLarue7/23/911330275/23/0711.44

AmandaLarue7/23/911330274/10/0724.54

AmandaLarue7/23/911330277/25/075.5

AmandaLarue7/23/911330279/26/0717.82

AmandaLarue7/23/9113302710/12/0715.04

AmandaLarue7/23/9113302711/27/0713.83

JACKIELYNDS11/16/871330886/13/0797.15

KATEMARSHALL6/13/991453031/10/0773.47

KATEMARSHALL6/13/991453033/15/0762.56

KATEMARSHALL6/13/991453035/9/0761.74

KATEMARSHALL6/13/991453038/8/0755.32

KATEMARSHALL6/13/9914530311/14/0762.57

TAYLORMARTIN3/7/971441312/28/0744.34

TAYLORMARTIN3/7/971441316/13/0734.55

TAYLORMARTIN3/7/971441318/22/0713.45

TAYLORMARTIN3/7/9714413110/1/0716.63

TAYLORMARTIN3/7/9714413111/14/078.85

TAYLORMARTIN3/7/9714413112/12/0716.95

ASHLEIGHMERCHANT12/7/971429881/24/0720.82





SheaMessier5/6/961412556/18/0726.79

SheaMessier5/6/961412557/25/0726.06

SheaMessier5/6/961412559/12/0717.31

SheaMessier5/6/9614125510/17/0711.17

ABBEYMITCHELL2/14/961419591/10/0720.25

ABBEYMITCHELL2/14/961419592/16/0729.57

ABBEYMITCHELL2/14/961419594/11/0737.48

ABBEYMITCHELL2/14/961419593/27/0729.42

ABBEYMITCHELL2/14/961419597/11/0726.24

ABBEYMITCHELL2/14/961419599/10/0723.49

ABBEYMITCHELL2/14/9614195912/12/0718.84

SEANMORIARTY7/1/021478031/24/0762.98

SEANMORIARTY7/1/021478034/25/0769.33

SEANMORIARTY7/1/021478037/25/0764.91

SEANMORIARTY7/1/0214780310/10/0749.23

SEANMORIARTY7/1/0214780310/24/0762.48

BRIANO'CONNOR6/29/921351724/11/0750.37

BRIANO'CONNOR6/29/921351721/10/0746.18

BRIANO'CONNOR6/29/921351728/22/0747.1

BRIANO'CONNOR6/29/9213517211/14/0762.67

SARAHOUELLETTE2/10/941383743/28/0715.02

SARAHOUELLETTE2/10/941383746/29/0720.73

SARAHOUELLETTE2/10/941383749/12/0711.89

SARAHOUELLETTE2/10/9413837412/12/0714.48

JAREDOVERLOCK8/4/981430741/24/0732.15

JAREDOVERLOCK8/4/981430745/9/0741.46

JAREDOVERLOCK8/4/981430748/8/0732.48

JAREDOVERLOCK8/4/9814307411/28/0757.42

MICHAELPENDEXTER9/16/961420464/11/0794.35


AmberPilotte12/16/931381543/28/0740.08

AmberPilotte12/16/931381546/27/0731.83

AmberPilotte12/16/9313815410/10/0739.05

HOGANREED9/15/961443321/2/0730.09

HOGANREED9/15/961443324/11/0744.98

HOGANREED9/15/961443326/27/0741.38

HOGANREED9/15/961443328/24/0727.84

HOGANREED9/15/9614433210/19/0738.04

HOGANREED9/15/9614433210/24/0735.78

HOGANREED9/15/9614433212/7/0736.4

NICOLEREYNOLDS1/15/951396251/10/0742.13

NICOLEREYNOLDS1/15/951396251/16/0740.13

NICOLEREYNOLDS1/15/951396252/5/0744.53

NICOLEREYNOLDS1/15/951396253/28/0739.32

NICOLEREYNOLDS1/15/951396254/19/0747.75

NICOLEREYNOLDS1/15/951396255/9/0752.68

NICOLEREYNOLDS1/15/951396258/8/0738.71

NICOLEREYNOLDS1/15/9513962510/24/0745.54

VANESSAROACH8/2/911355262/28/0765.89

VANESSAROACH8/2/911355265/23/0768.07

VANESSAROACH8/2/911355268/22/0769.16

VANESSAROACH8/2/9113552612/12/0771.92

EliRogers4/17/041509392/15/072.91

EliRogers4/17/041509393/8/077.58

EliRogers4/17/041509394/25/072.22

EliRogers4/17/041509396/13/072.53

EliRogers4/17/041509398/22/0718.94

BETHANYSCHULBERG11/23/941410261/10/0712.41





ashleysenato12/19/891487631/24/0767.59

HANNAHSTOREY4/10/001457221/24/0724.55

HANNAHSTOREY4/10/001457223/1/0734.2

HANNAHSTOREY4/10/001457224/11/0747.4

HANNAHSTOREY4/10/001457227/31/0729.41

HANNAHSTOREY4/10/0014572210/3/0728.41

HANNAHSTOREY4/10/0014572211/14/0722.38

AARONTHIBOUTOT8/2/931384312/28/0770.64

AARONTHIBOUTOT8/2/931384314/11/0771.01

AARONTHIBOUTOT8/2/931384315/4/0773.66

AARONTHIBOUTOT8/2/931384318/8/0761.79

AARONTHIBOUTOT8/2/9313843111/14/0768.57

MACKENZIETOMPKINS3/10/021481103/14/0741.17




40.13

08BMI

First NameLast NameBirth DateCFFIDDate of Clinical VisitBMI PercentileMedian BMI

williamAlger11/21/051559254/23/0865.112008 Q142.365

williamAlger11/21/051559253/3/0846.5

williamAlger11/21/051559257/23/0859.2

williamAlger11/21/0515592512/17/0848.12

williamAlger11/21/051559259/16/0879.36

RACHELANDERSON5/30/941412945/14/0885.79

RACHELANDERSON5/30/9414129410/8/0882.03

RACHELANDERSON5/30/941412944/23/0887.79

josephauclair1/21/911328824/23/0849.95

josephauclair1/21/911328825/7/0854.35

josephauclair1/21/911328826/11/0846.63

josephauclair1/21/911328828/13/0824.74

josephauclair1/21/9113288210/8/0828.8

MELAYNABENNER11/27/001447103/12/0837.36

MELAYNABENNER11/27/001447106/25/0833.25

MELAYNABENNER11/27/001447107/25/0819.69

MELAYNABENNER11/27/0014471010/8/0831.5

MELAYNABENNER11/27/0014471012/18/0830.64

BethanyBernard10/3/911492911/23/0831.47

BethanyBernard10/3/911492915/28/0829.8

BethanyBernard10/3/911492917/23/0820.48

BethanyBernard10/3/911492918/18/0821.61

BethanyBernard10/3/911492916/23/0816

BethanyBernard10/3/911492916/20/0816

BethanyBernard10/3/911492919/24/0816.46

BethanyBernard10/3/911492918/1/0819.52

BethanyBernard10/3/9114929110/14/0817.7

BethanyBernard10/3/9114929112/2/0835.91

BethanyBernard10/3/9114929110/24/0814.42

BethanyBernard10/3/9114929110/20/0814.42

GabrielBiasuz7/30/041516597/7/0879.19

GabrielBiasuz7/30/0415165910/8/0882.53

GabrielBiasuz7/30/0415165911/19/0891.78

SARABLAIR6/9/981435773/12/0844.75

SARABLAIR6/9/981435776/11/0832.27

SARABLAIR6/9/981435779/10/0857.05

SARABLAIR6/9/9814357710/6/0850.36

SARABLAIR6/9/9814357712/10/0842.32



MIROSLAVBOLDUC6/10/881006714/30/080.02




MIROSLAVBOLDUC6/10/8810067110/20/080.16

MIROSLAVBOLDUC6/10/8810067112/24/080.25



SEANBOURGEOIS8/16/891357743/26/0850.67

SEANBOURGEOIS8/16/891357747/23/0840.49

SEANBOURGEOIS8/16/891357749/11/0838.75

SEANBOURGEOIS8/16/8913577411/12/0840.34

SEANBOURGEOIS8/16/891357742/19/0840.42

ZacharyBowman8/30/051533563/26/0884.26

ZacharyBowman8/30/051533566/25/0872.39

ZacharyBowman8/30/051533569/10/0888.31

ZacharyBowman8/30/0515335612/10/0876.18

BEATRICEBRAEUER6/21/961505568/27/0862.66






ALLISONBRANN2/25/001459822/27/0896.04

ALLISONBRANN2/25/001459825/14/0896.4

ALLISONBRANN2/25/001459828/13/0894.68

ALLISONBRANN2/25/0014598211/4/0896.11

ALLISONBRANN2/25/0014598211/12/0895.09

ALLISONBRANN2/25/0014598212/2/0894.08






AdrianaBrown7/5/971512033/12/0884.88

AdrianaBrown7/5/971512032/21/0883.43

AdrianaBrown7/5/971512035/28/0886.62

AdrianaBrown7/5/971512038/13/0887.95

AdrianaBrown7/5/9715120311/12/0890.56

AdrianaBrown7/5/9715120312/22/0892.24

SYDNEYBROWN12/20/981447623/26/0843.09

SYDNEYBROWN12/20/981447629/24/0819.58

EZEKIELBRYANT10/20/001460021/9/0874.78

EZEKIELBRYANT10/20/001460022/11/0873.34

EZEKIELBRYANT10/20/001460024/9/0873.81

EZEKIELBRYANT10/20/001460027/9/0856.8

EZEKIELBRYANT10/20/0014600210/29/0873.35









LeviBushman12/6/011576331/9/0835.33

LeviBushman12/6/011576334/23/0823.68

LeviBushman12/6/011576339/24/0830.46

LeviBushman12/6/0115763311/12/0822.07





TrinityCaswell8/18/051534143/12/085.3

TrinityCaswell8/18/051534146/11/0817.16

TrinityCaswell8/18/051534149/10/086.25



MeganCousert7/5/901336362/8/0877.91

MeganCousert7/5/901336364/23/0877.47

MeganCousert7/5/901336367/9/0862.78

MeganCousert7/5/901336367/25/0874.58

MeganCousert7/5/901336368/27/0872.77

MeganCousert7/5/9013363611/17/0868.67

MeganCousert7/5/9013363611/20/0864.51

MeganCousert7/5/901336361/7/0883.63

MeganCousert7/5/901336366/2/0882.77

MeganCousert7/5/9013363610/15/0873.91

MeganCousert7/5/901336366/9/0882.77

MeganCousert7/5/901336367/14/0886.7

MeganCousert7/5/9013363610/20/0873.91

MeganCousert7/5/9013363610/27/0873.91

MeganCousert7/5/9013363610/30/0873.91

MeganCousert7/5/9013363611/3/0868.67

OwenCrowley8/6/021472971/9/088.15

OwenCrowley8/6/021472973/26/0822.77

OwenCrowley8/6/021472975/6/0824.07

OwenCrowley8/6/021472975/20/0831.32

OwenCrowley8/6/021472976/4/0825.99

OwenCrowley8/6/021472977/23/0817.7

OwenCrowley8/6/0214729710/8/0815.61

OwenCrowley8/6/0214729710/27/0840.45

OwenCrowley8/6/0214729710/28/0830.06

OwenCrowley8/6/0214729711/26/0857.63

PiperDavidson6/2/041512022/11/0840.27

PiperDavidson6/2/041512024/29/0831.19

PiperDavidson6/2/041512029/10/0840.39

PiperDavidson6/2/0415120211/26/0823.55

NicoleDawson6/9/051531341/23/0876.93

NicoleDawson6/9/051531344/9/0887.33

NicoleDawson6/9/051531346/10/0877.06

NicoleDawson6/9/051531346/25/0885.4

NicoleDawson6/9/051531349/10/0891.02

NicoleDawson6/9/0515313411/18/0894.26

NicoleDawson6/9/0515313412/10/0887.5

DEONDENIS4/13/991437341/23/0846.06

DEONDENIS4/13/991437344/9/0853.17

DEONDENIS4/13/991437345/28/0863.77

DEONDENIS4/13/991437348/27/0878.91

DEONDENIS4/13/991437349/19/0878.29

DEONDENIS4/13/9914373411/12/0883.9

AMBERDOSTIE2/17/971415521/9/0827.71

AMBERDOSTIE2/17/971415522/11/0826.15

AMBERDOSTIE2/17/971415523/3/0822.54

AMBERDOSTIE2/17/971415524/23/0834.44

AMBERDOSTIE2/17/971415524/21/0834.44

AMBERDOSTIE2/17/971415528/13/0820.5

AMBERDOSTIE2/17/9714155211/12/0815.22

AMBERDOSTIE2/17/9714155212/15/0827.13

AMBERDOSTIE2/17/971415522/19/0836.52

AMBERDOSTIE2/17/9714155211/20/0817.58

RachaelDubois6/5/911514552/27/0864.41

RachaelDubois6/5/911514553/26/0862.74

RachaelDubois6/5/911514556/27/0853.93

RachaelDubois6/5/911514557/30/0850.36

RachaelDubois6/5/911514559/2/0853.86

RachaelDubois6/5/911514559/25/0844.68

RachaelDubois6/5/9115145510/7/0844.24

RachaelDubois6/5/9115145510/29/0853.94

RachaelDubois6/5/911514558/13/0849.93

RichardDubois4/24/891399207/30/0898.29

trentonellis7/19/021487703/12/0870.02

trentonellis7/19/021487709/10/0861.99

trentonellis7/19/0214877012/10/080.24

EMMAEWY3/24/951415827/23/0855.57

EMMAEWY3/24/9514158210/29/0860.91

JarodFarrar7/20/981437992/27/0875.63

JarodFarrar7/20/981437995/15/0874.76

JarodFarrar7/20/981437996/11/0873.49

JarodFarrar7/20/981437994/21/0823.13

JarodFarrar7/20/981437999/10/0877.2

JarodFarrar7/20/9814379912/10/0875.74

erinfarrell6/19/051534166/18/0818.25

erinfarrell6/19/051534167/23/0813.65

erinfarrell6/19/0515341610/29/0816.35

erinfarrell6/19/0515341612/2/0837.03

erinfarrell6/19/051534161/8/0817.12

CalebFlagg7/23/011474071/23/0878.08

CalebFlagg7/23/011474074/23/0883.55

CalebFlagg7/23/0114740710/29/0873.17

CalebFlagg7/23/011474077/23/0874.9

TylerFlaherty7/11/9514043710/8/086.09

TylerFlaherty7/11/9514043712/29/084.02

CAILYNFOWLER1/5/951392121/2/0840.74

CAILYNFOWLER1/5/951392121/23/0836.33

CAILYNFOWLER1/5/951392124/9/0822.58

CAILYNFOWLER1/5/951392125/14/0848.82

CAILYNFOWLER1/5/951392128/27/0854.76

CAILYNFOWLER1/5/951392129/19/0851.01

CAILYNFOWLER1/5/9513921210/15/0847.18

CAILYNFOWLER1/5/9513921210/31/0856.26

CAILYNFOWLER1/5/9513921211/26/0851.93

CAILYNFOWLER1/5/9513921211/4/0850.03

CAILYNFOWLER1/5/9513921211/10/0846.83

CAILYNFOWLER1/5/9513921211/13/0846.83

CAILYNFOWLER1/5/951392122/29/0842.16

CAILYNFOWLER1/5/951392123/31/0845.97

CAILYNFOWLER1/5/9513921212/23/0844.43

CAILYNFOWLER1/5/951392124/13/0843.81

KaylebFreeman8/4/051540653/12/0896.58

KaylebFreeman8/4/051540655/28/0896.93

KaylebFreeman8/4/051540658/13/0892.76

KaylebFreeman8/4/0515406511/12/0878.26

TrevorGallant12/21/971572141/9/0850.29

TrevorGallant12/21/971572143/26/0853.66

TrevorGallant12/21/971572146/25/0847.17

TrevorGallant12/21/971572149/24/0858.97

TrevorGallant12/21/9715721412/10/0857.04

AustinGarey12/27/041526174/9/0852.8

AustinGarey12/27/041526177/23/0874.96

AustinGarey12/27/0415261710/29/0879.3

JERRICAGAY5/20/911367802/27/0886.19

JERRICAGAY5/20/911367805/14/0871.77

JERRICAGAY5/20/911367807/23/0856.56

JERRICAGAY5/20/9113678010/29/0851.9

JERRICAGAY5/20/9113678012/24/0845.07

MARKIGAY1/14/901006722/25/0836.57

MARKIGAY1/14/901006727/30/0815.65

MARKIGAY1/14/901006728/13/0817.78

MARKIGAY1/14/901006723/19/0830.97

MARKIGAY1/14/901006723/21/0830.97

MARKIGAY1/14/901006723/24/0814.65

MARKIGAY1/14/901006724/1/0814.4

MARKIGAY1/14/901006723/27/0814.65

RACHAELGEROW12/15/971462654/9/0844.05

RACHAELGEROW12/15/971462657/9/0845.13

RACHAELGEROW12/15/9714626511/12/0854.05

EDWARDGILBLAIR3/14/921351712/12/080.51

EDWARDGILBLAIR3/14/921351713/12/080.54

EDWARDGILBLAIR3/14/921351711/29/080.4

EDWARDGILBLAIR3/14/921351715/28/080.92

EDWARDGILBLAIR3/14/921351717/17/080.34

EDWARDGILBLAIR3/14/921351717/28/080.17

EDWARDGILBLAIR3/14/9213517111/12/080.19

EDWARDGILBLAIR3/14/9213517112/9/080.65

MalcolmHolteen1/14/941605233/25/0870.41

MalcolmHolteen1/14/941605236/25/0853.78

MalcolmHolteen1/14/941605239/10/0853.81














ETHANJALBERT12/16/991439991/9/0893.85

ETHANJALBERT12/16/991439993/26/0894.84

ETHANJALBERT12/16/991439997/9/0894.78

ETHANJALBERT12/16/9914399910/8/0895.73

ETHANJALBERT12/16/9914399912/22/0894.14

CAMERONJOHNSON9/14/971417773/4/0838.16

CAMERONJOHNSON9/14/971417777/24/0843.35

CAMERONJOHNSON9/14/9714177711/19/0847.37

JacksonKnobloch1/22/0516058712/10/0811.44














AmandaLarue7/23/911330273/12/085.49

AmandaLarue7/23/911330277/8/082.55

AmandaLarue7/23/911330278/13/084.59

AmandaLarue7/23/9113302711/19/089.54

AmandaLarue7/23/9113302712/24/087.71

KATEMARSHALL6/13/991453032/27/0862.57

KATEMARSHALL6/13/991453035/14/0861.58

KATEMARSHALL6/13/991453038/27/0870.19

KATEMARSHALL6/13/9914530310/8/0869.11

TAYLORMARTIN3/7/971441311/23/0837.76

TAYLORMARTIN3/7/971441312/4/0842.6

TAYLORMARTIN3/7/971441313/26/0851

TAYLORMARTIN3/7/971441316/25/0836

TAYLORMARTIN3/7/971441318/25/0821.6

TAYLORMARTIN3/7/971441319/24/0832.42

TAYLORMARTIN3/7/9714413111/12/0822.52








SheaMessier5/6/961412551/11/083.57

SheaMessier5/6/961412551/22/082.09

SheaMessier5/6/961412554/28/084.6

SheaMessier5/6/961412555/12/082.5

SheaMessier5/6/961412555/27/082.98

SheaMessier5/6/961412557/21/082.73

SheaMessier5/6/961412556/9/082.58

SheaMessier5/6/961412556/16/0810.29

SheaMessier5/6/961412556/13/081.1

SheaMessier5/6/961412559/18/080.66

SheaMessier5/6/9614125510/14/081.21

SheaMessier5/6/961412559/23/080.66

ABBEYMITCHELL2/14/961419591/9/0821.94

ABBEYMITCHELL2/14/961419591/29/0826.96

ABBEYMITCHELL2/14/961419593/7/0829.49

ABBEYMITCHELL2/14/961419595/14/0828.87

ABBEYMITCHELL2/14/961419597/23/0819.99

ABBEYMITCHELL2/14/961419598/18/0828.92

ABBEYMITCHELL2/14/961419599/24/0824

ABBEYMITCHELL2/14/9614195911/26/0825.92

SEANMORIARTY7/1/021478031/23/0862.09

SEANMORIARTY7/1/021478034/9/0857.69

SEANMORIARTY7/1/021478037/9/0850.36

SEANMORIARTY7/1/0214780310/8/0859

LeilaniMyers1/25/061565864/9/0840.75

LeilaniMyers1/25/061565867/9/0816.96

LeilaniMyers1/25/0615658611/12/0827.04

AnikaNaher5/13/961419898/26/0884.83

AnikaNaher5/13/9614198910/29/0884.49

BRIANO'CONNOR6/29/921351722/27/0858.49

BRIANO'CONNOR6/29/921351725/14/0856.84

BRIANO'CONNOR6/29/921351728/27/0852.57

BRIANO'CONNOR6/29/9213517211/20/0841.88

BRIANO'CONNOR6/29/9213517212/4/0841.13

SARAHOUELLETTE2/10/941383743/12/0823.53

SARAHOUELLETTE2/10/941383748/27/0817.63

SARAHOUELLETTE2/10/9413837411/26/0824.22

SARAHOUELLETTE2/10/9413837412/24/0825.4

SARAHOUELLETTE2/10/9413837412/30/0831.98

JAREDOVERLOCK8/4/981430743/19/0860.27

JAREDOVERLOCK8/4/9814307411/26/0862.53




blakepettengill8/7/061554789/10/0839.54



AmberPilotte12/16/931381543/26/0829.32

AmberPilotte12/16/931381545/1/0843.97

AmberPilotte12/16/931381546/2/0853.63

AmberPilotte12/16/931381548/13/0862.14

AmberPilotte12/16/931381545/23/0842.92

AmberPilotte12/16/9313815411/12/0866.06

AmberPilotte12/16/9313815412/9/0863.77

AmberPilotte12/16/9313815412/11/0862.89

HOGANREED9/15/961443321/23/0838.89

HOGANREED9/15/961443325/21/0835.77

HOGANREED9/15/961443326/3/0843.18

HOGANREED9/15/961443326/18/0844.64

HOGANREED9/15/961443327/2/0838.31

HOGANREED9/15/961443328/4/0826.15

HOGANREED9/15/961443328/29/0836.57

HOGANREED9/15/961443329/24/0834.43

HOGANREED9/15/9614433211/3/0829.06

HOGANREED9/15/9614433211/19/0840.16

HOGANREED9/15/9614433212/8/0842.73

HOGANREED9/15/961443329/17/0824.1

HOGANREED9/15/9614433211/4/0832.52

NICOLEREYNOLDS1/15/951396251/23/0850.47

NICOLEREYNOLDS1/15/951396255/28/0846.3

NICOLEREYNOLDS1/15/951396259/24/0844.53

NICOLEREYNOLDS1/15/9513962511/7/0855.76

NICOLEREYNOLDS1/15/9513962511/17/0859.57

NICOLEREYNOLDS1/15/9513962512/10/0859.08

NICOLEREYNOLDS1/15/9513962511/21/0869.7

VANESSAROACH8/2/911355263/12/0870.98

VANESSAROACH8/2/911355267/9/0874.35

VANESSAROACH8/2/9113552610/8/0873.56

EliRogers4/17/041509391/7/082.66

EliRogers4/17/041509392/11/0841.96

EliRogers4/17/041509392/27/0833.74

EliRogers4/17/041509394/7/0872.7

EliRogers4/17/041509396/25/0862.36

EliRogers4/17/041509399/10/0863.39

EliRogers4/17/0415093912/10/0867.21

EliRogers4/17/041509391/15/087.41








TylerSlocum11/2/051536561/4/0885.38

TylerSlocum11/2/051536564/17/0888.04

TylerSlocum11/2/051536565/14/0889.72

TylerSlocum11/2/051536566/13/0897.39

TylerSlocum11/2/051536568/13/0892.2

TylerSlocum11/2/0515365611/12/0897.61

TylerSlocum11/2/0515365612/9/0897.81

TylerSlocum11/2/0515365612/22/0897.53

HANNAHSTOREY4/10/001457222/13/0826.71

HANNAHSTOREY4/10/001457224/23/0828.99

HANNAHSTOREY4/10/001457227/23/0828.59

HANNAHSTOREY4/10/0014572210/29/0825.39

HANNAHSTOREY4/10/0014572212/24/0834.86

AARONTHIBOUTOT8/2/931384312/11/0852.46

AARONTHIBOUTOT8/2/931384312/27/0858.16

AARONTHIBOUTOT8/2/931384313/12/0854.92

AARONTHIBOUTOT8/2/931384315/14/0848.96

AARONTHIBOUTOT8/2/931384313/31/0858.2

AARONTHIBOUTOT8/2/931384318/27/0844.87

AARONTHIBOUTOT8/2/9313843111/26/0849.35

AARONTHIBOUTOT8/2/931384313/17/0867.91

WILLIAMTHIELE10/4/0615667812/17/0867.97





PaigeWales11/18/001458081/9/0810.98

PaigeWales11/18/001458081/22/0831.04

PaigeWales11/18/001458081/29/0817.63

PaigeWales11/18/001458083/26/0841.6

PaigeWales11/18/001458085/23/0824.06

PaigeWales11/18/001458086/25/0819.48

PaigeWales11/18/001458087/9/0844.91

PaigeWales11/18/001458089/10/0843.2

PaigeWales11/18/001458089/22/0820.23

PaigeWales11/18/0014580811/12/0821.68

PaigeWales11/18/0014580812/3/0824.57

PaigeWales11/18/0014580812/24/0842.41

PaigeWales11/18/0014580811/18/0816.49

09BMI

First NameLast NameBirth DateCFFIDDate of Clinical VisitBMI PercentileMedian BMI

williamAlger11/21/051559251/27/0970.852009 Q148.09

RACHELANDERSON5/30/941412941/14/0985.142009 Q246.9

josephauclair1/21/911328823/11/0933.162009 Q346.66

MELAYNABENNER11/27/001447101/14/0922.37

MELAYNABENNER11/27/001447102/23/0929.77

BethanyBernard10/3/911492912/2/0932.59

SARABLAIR6/9/981435772/25/0939.21

SARABLAIR6/9/981435773/11/0953.6

SEANBOURGEOIS8/16/891357741/21/0940.81




ALLISONBRANN2/25/001459823/18/0995.36


AdrianaBrown7/5/971512032/11/0992.36



AARONBURGESS3/28/911330262/11/0964.86

LeviBushman12/6/011576331/7/0924.74


TrinityCaswell8/18/051534141/14/0927.9

TrinityCaswell8/18/051534143/25/0924.97

MeganCousert7/5/901336361/6/0952.53

MeganCousert7/5/901336362/10/0953.88

MeganCousert7/5/901336363/10/0953.61

AmayaCressey3/14/071568313/25/0944.56

OwenCrowley8/6/021472972/11/0955.79

PiperDavidson6/2/041512022/25/0948.48

PiperDavidson6/2/041512023/25/0931.39

NicoleDawson6/9/051531343/11/0988.21

DEONDENIS4/13/991437342/25/0967.17

AMBERDOSTIE2/17/971415522/11/0923.55

RachaelDubois6/5/911514551/21/0951.41

RichardDubois4/24/891399202/25/0998.73

EMMAEWY3/24/951415821/14/0955.7

JarodFarrar7/20/981437993/11/0975.02

CalebFlagg7/23/011474072/11/0980.15

TylerFlaherty7/11/951404371/28/098.61

CAILYNFOWLER1/5/951392121/14/0943.26

CAILYNFOWLER1/5/951392121/30/0943.86

CAILYNFOWLER1/5/951392122/11/0940.44

CAILYNFOWLER1/5/951392122/9/0944.4

KaylebFreeman8/4/051540652/25/0977.8

KylaGaffney12/27/061590001/14/0990.57

KylaGaffney12/27/061590002/24/0986.91

TrevorGallant12/21/971572143/11/0954.07

AustinGarey12/27/041526173/25/0978.8

JERRICAGAY5/20/911367802/25/0955.55

EDWARDGILBLAIR3/14/921351711/20/090.26

EDWARDGILBLAIR3/14/921351713/18/092.27

MalcolmHolteen1/14/941605231/14/0950.53





ETHANJALBERT12/16/991439991/14/0994.39






AmandaLarue7/23/911330271/2/098.11

AmandaLarue7/23/911330272/20/0932.83

KATEMARSHALL6/13/991453031/14/0968.05

TAYLORMARTIN3/7/971441311/26/0927.57

TAYLORMARTIN3/7/971441313/25/0921.87


SheaMessier5/6/961412551/5/090.86

ABBEYMITCHELL2/14/961419592/6/0924.99

ABBEYMITCHELL2/14/961419592/25/0930.46

SEANMORIARTY7/1/021478031/14/0967.47

LeilaniMyers1/25/061565862/20/0955.19

AnikaNaher5/13/961419891/21/0981.25

AnikaNaher5/13/961419892/12/0979.56

AnikaNaher5/13/961419893/16/0986

BRIANO'CONNOR6/29/921351721/21/0941.84

BRIANO'CONNOR6/29/921351723/11/0934.49

SARAHOUELLETTE2/10/941383742/11/0922.98

SARAHOUELLETTE2/10/941383743/25/0918.63


AmberPilotte12/16/931381541/12/0968.62

AmberPilotte12/16/931381542/25/0963.32

HOGANREED9/15/961443323/25/0943.73

NICOLEREYNOLDS1/15/951396251/13/0959.44

NICOLEREYNOLDS1/15/951396253/9/0947.14

VANESSAROACH8/2/911355261/14/0967.36

EliRogers4/17/041509393/11/0956.23


TylerSlocum11/2/051536561/20/0995.92

TylerSlocum11/2/051536562/25/0998.14

AARONTHIBOUTOT8/2/931384312/25/0947.92

WILLIAMTHIELE10/4/061566783/11/0947.62




PaigeWales11/18/001458082/11/0966.43

PaigeWales11/18/001458083/16/0972.21

williamAlger11/21/051559256/15/0978.6

RACHELANDERSON5/30/941412944/8/0983.57

josephauclair1/21/911328826/24/0932.15

MELAYNABENNER11/27/001447105/13/0910.99

BethanyBernard10/3/911492914/22/0942.33

SARABLAIR6/9/981435775/13/0934.07

SARABLAIR6/9/981435776/24/0943.54

SEANBOURGEOIS8/16/891357745/11/0946.66

SEANBOURGEOIS8/16/891357745/26/0952.74

ZacharyBowman8/30/051533564/8/0984.39

ALLISONBRANN2/25/001459826/10/0995.32


AdrianaBrown7/5/971512036/10/0989.82

SYDNEYBROWN12/20/981447624/22/0927.17

EZEKIELBRYANT10/20/001460026/24/0962.93



LeviBushman12/6/011576334/15/0911.45

LeviBushman12/6/011576335/13/0936.05

LeviBushman12/6/011576335/18/0923.26

LeviBushman12/6/011576335/26/0923.26

LeviBushman12/6/011576336/24/0912.76


TrinityCaswell8/18/051534146/10/0940.64

MeganCousert7/5/901336365/27/0964.35

PiperDavidson6/2/041512025/27/0944.03

NicoleDawson6/9/051531346/10/0977.31

DEONDENIS4/13/991437344/22/0977.91

AMBERDOSTIE2/17/971415525/13/0943.16

AMBERDOSTIE2/17/971415526/17/0946.58

RachaelDubois6/5/911514554/27/0940.2

trentonellis7/19/021487704/22/0946.61

EMMAEWY3/24/951415824/22/0948.21

EMMAEWY3/24/951415826/24/0948.48

JarodFarrar7/20/981437994/9/0982.29

JarodFarrar7/20/981437995/13/0978.78

JarodFarrar7/20/981437995/28/0981.4

erinfarrell6/19/051534164/8/0949.59

erinfarrell6/19/051534166/11/0931.22

erinfarrell6/19/051534166/24/0937.42

CalebFlagg7/23/011474075/27/0992.85

CAILYNFOWLER1/5/951392124/2/0935.73

CAILYNFOWLER1/5/951392125/20/0932.78

KaylebFreeman8/4/051540655/13/0967.2

TrevorGallant12/21/971572146/24/0937.82

AustinGarey12/27/041526176/24/0985.27

JERRICAGAY5/20/911367804/8/0949.49

JERRICAGAY5/20/911367805/27/0953.02

RACHAELGEROW12/15/971462654/8/0960.31

EDWARDGILBLAIR3/14/921351714/14/095.45

EDWARDGILBLAIR3/14/921351715/29/090.55

MalcolmHolteen1/14/941605234/8/0945.75




ETHANJALBERT12/16/991439994/8/0991.42



NovaleeMadore5/1/071570535/13/0971.63

KATEMARSHALL6/13/991453034/3/0974.4

KATEMARSHALL6/13/991453036/24/0974.84

TAYLORMARTIN3/7/971441314/27/0933.8

TAYLORMARTIN3/7/971441316/24/0918.25



ABBEYMITCHELL2/14/961419594/8/0929.09

ABBEYMITCHELL2/14/961419596/2/0934.82

SEANMORIARTY7/1/021478034/22/0939.9

AnikaNaher5/13/961419894/8/0982.13

BRIANO'CONNOR6/29/921351724/22/0939.69

SARAHOUELLETTE2/10/941383745/13/0917.75

JAREDOVERLOCK8/4/981430744/8/0973.85



AmberPilotte12/16/931381546/24/0961.91

HOGANREED9/15/961443325/18/0936.39

HOGANREED9/15/961443326/10/0941.58

NICOLEREYNOLDS1/15/951396254/22/0957.1

NICOLEREYNOLDS1/15/951396256/22/0960.59

EliRogers4/17/041509396/10/0971.43


TylerSlocum11/2/051536565/13/0998.38

HANNAHSTOREY4/10/001457224/22/0929.8

HANNAHSTOREY4/10/001457225/26/0938.56

HANNAHSTOREY4/10/001457226/8/0940.49

AARONTHIBOUTOT8/2/931384315/13/0935.14

AARONTHIBOUTOT8/2/931384316/26/0945.92

WILLIAMTHIELE10/4/061566786/9/0954.01

WILLIAMTHIELE10/4/061566786/17/0945.29


PaigeWales11/18/001458084/15/0977.26

PaigeWales11/18/001458086/15/0985.56

PaigeWales11/18/001458086/17/0974.36

williamAlger11/21/051559257/29/0969.4

RACHELANDERSON5/30/941412948/12/0982.03

josephauclair1/21/911328829/24/0928.34

MELAYNABENNER11/27/001447107/22/0911.32

MELAYNABENNER11/27/001447109/24/0910.93

BethanyBernard10/3/911492917/29/0927.92

GabrielBiasuz7/30/041516597/29/0976.3

GabrielBiasuz7/30/041516599/24/0979.22

SARABLAIR6/9/981435779/23/0957.67

CarterBlanche7/29/071600078/12/0972.92

ZacharyBowman8/30/051533567/22/0926.89




AdrianaBrown7/5/971512039/9/0988.73

EZEKIELBRYANT10/20/001460028/18/0962.42

EZEKIELBRYANT10/20/001460029/23/0971.77

LeviBushman12/6/011576337/22/0917.25

LeviBushman12/6/011576339/24/0913.91

TrinityCaswell8/18/051534147/29/0930.2


MeganCousert7/5/901336367/22/0965.18

AmayaCressey3/14/071568319/23/0929.2

OwenCrowley8/6/021472979/9/0978.73

PiperDavidson6/2/041512029/9/0911.85

DEONDENIS4/13/991437347/22/0984.38

AMBERDOSTIE2/17/971415527/29/0933.78

RachaelDubois6/5/911514559/9/0938.45

trentonellis7/19/021487707/22/0954.82

JarodFarrar7/20/981437997/22/0985.61

JarodFarrar7/20/981437999/23/0982.93

CAILYNFOWLER1/5/951392127/6/0930.64

CAILYNFOWLER1/5/951392129/9/0942.2

CAILYNFOWLER1/5/951392129/21/0941.62

KaylebFreeman8/4/051540658/12/0989.49

TrevorGallant12/21/971572149/16/0956.11

AustinGarey12/27/041526179/9/0968.28

JERRICAGAY5/20/911367808/12/0952.76

RACHAELGEROW12/15/971462657/22/0957.04

EDWARDGILBLAIR3/14/921351717/29/090

EDWARDGILBLAIR3/14/921351718/5/090.04

EDWARDGILBLAIR3/14/921351718/19/090.1

EDWARDGILBLAIR3/14/921351719/9/090.04

MalcolmHolteen1/14/941605237/22/0941.47




ETHANJALBERT12/16/991439997/22/0989.54

CAMERONJOHNSON9/14/971417777/15/0942.91

CAMERONJOHNSON9/14/971417777/24/0922.52


AmandaLarue7/23/911330278/12/096.05

AyishaLemont5/20/071577798/12/095.57

NovaleeMadore5/1/071570538/12/0949.29

TAYLORMARTIN3/7/971441317/13/0927.81

TAYLORMARTIN3/7/971441319/9/0936.32



ABBEYMITCHELL2/14/961419599/24/0926.48

SEANMORIARTY7/1/021478037/22/0938

LeilaniMyers1/25/061565868/28/0927.97

AnikaNaher5/13/961419897/22/0981.06

AnikaNaher5/13/961419898/26/0979.42

BRIANO'CONNOR6/29/921351727/29/0931.97

BRIANO'CONNOR6/29/921351728/26/0919.3

JAREDOVERLOCK8/4/981430748/12/0972.33


AmberPilotte12/16/931381549/16/0962.73

HOGANREED9/15/961443328/12/0926.74

NICOLEREYNOLDS1/15/951396257/22/0950.1

EliRogers4/17/041509398/26/0956.67


HANNAHSTOREY4/10/001457228/12/0939.64

HANNAHSTOREY4/10/001457229/21/0949.63

AARONTHIBOUTOT8/2/931384317/21/0948.47

AARONTHIBOUTOT8/2/931384318/19/0953.85

AARONTHIBOUTOT8/2/931384319/14/0946.21

WILLIAMTHIELE10/4/061566789/23/0963.39


Sustaining a QI processThe project leader needs to continually reassess process and outcomeThe team needs to stay focused and feel excited about the goalsRun charts in clinic show progress and provide encouragementReward your team and your patients when you achieve your goals!

Median Predicted Survival Age 1994-200625303540'94'95'96'97'98'99 '00 '01'02 '03 '04'05'06YearMedian Survival Age (years)Predicted survival improves from 28.6 years to 36.9 yearsFirst CFF Center reports reveal variabilityCFF QI Grant programCFF National Quality InitiativePredicted survival improves from 27.7 years to 28.6 years714 Lives

SummaryProviding exemplary CF care can prolong median survival Making data transparent identifies best practice, provides incentive to improveBenchmarking best practicing sites is effectiveIncorporate families into quality improvement Share effective systems of QI

Our CF Team

Edvard Munch: The ScreamASlide 1: BackgroundIn 2006 we began to look at how we scheduled our bi-monthly cystic fibrosis clinics. *Specifically We focused on one of the foundations 7 worthy goals which was *To decrease the spread of germs between people with cystic fibrosis . Some of the factors that prompted us to change our system included:* Families anxiety about acquiring new infections at clinic* the second factor was a permanent loss of 2 exam rooms due to office renovation. *At the same time we had an increase of 16 patients due to a satellite clinic closure.*Lastly, we knew newborn screen was on the horizon and wanted to make sure to protect those babies from pathogen exposure during clinic*Our ultimate goal was to separate patients based on respiratory culture history to limit the possibility of cross infection during clinic

a specialist’s story: my path to a mature quality improvement program ana cairns d.o. f.a.c.p....

Documents

cf modeladult

cf centersreactions

cf community2006

cf foundation2003

cf centersoutcomes

transparency of cf registry

cf centersultimate goal

life expectancy of cf