Quality Improvement Project to Improve Pediatric Constipation Management in Primary Care

Background: While functional constipation (FC) constitutes 3-5% of primary care visits, many primary care providers do not report familiarity with clinical practice guidelines (CPG) for diagnostic evaluation and treatment, and significant variations in management exist. Other chronic conditions have benefited from a clinical action plan (CAP) template to improve clinical outcomes with an individualized medication titration plan that acknowledges the multifactorial escalation of symptoms. Local Problem: Unmanaged constipation leads to increased financial burden and decreased quality of life for the patient and their family. This quality improvement project aimed to increase primary care provider knowledge of constipation treatment guidelines to improve the efficacy of patient education. Methods: Pre- and post-intervention surveys assessed providers' change in constipation management, knowledge of CPG, and usability of the charting templates as education tools. A chart review compared pre- and post-intervention treatment approaches. Interventions: Education was delivered to providers on Rome IV diagnostic criteria and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) CPG to manage FC. Charting templates including a CAP were constructed to implement in patient education. Results: A statistically significant increase in daily medications prescribed for at least two months per CPG recommendations (p<0.01). A statistically significant increase in provider-reported Rome IV and NASPGHAN knowledge and use (p<0.01). Providers reported changes to their management in medication selection (57%) and duration (81%), fiber education (43%), and other nonpharmacologic recommendations (38%). Conclusion: The results demonstrate increased provider-reported knowledge and use of CPG to manage FC and strong feasibility, usability, and intent to use the charting templates. The chart review, however, noticed a less dramatic change in education documented due to a low implementation rate. Future studies are needed to observe family-reported usability of the education templates and impact on health-related quality of life by measuring healthcare utilization outcomes.