Improvement of Free T4 in Newly Diagnosed Graves Disease Patients Through a Multifaceted Quality Improvement Approach

Authors

Einas H. Alkhatib, From the Division of Endocrinology/Diabetes, Department of Pediatrics, Children's National Hospital, Washington, D.C.
Tejal Patel, From the Division of Endocrinology/Diabetes, Department of Pediatrics, Children's National Hospital, Washington, D.C.
Julie Harlam, From the Division of Endocrinology/Diabetes, Department of Pediatrics, Children's National Hospital, Washington, D.C.
Padmaja Pavuluri, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, D.C.
Maria Naveed, Division of Endocrinology/Diabetes, Department of Pediatrics, Children's National Hospital, Washington, D.C.
Andrew Dauber, From the Division of Endocrinology/Diabetes, Department of Pediatrics, Children's National Hospital, Washington, D.C.
Priya Vaidyanathan, From the Division of Endocrinology/Diabetes, Department of Pediatrics, Children's National Hospital, Washington, D.C.

Document Type

Journal Article

Publication Date

1-1-2025

Journal

Pediatric quality & safety

Volume

10

Issue

4

DOI

10.1097/pq9.0000000000000824

Abstract

INTRODUCTION: Graves disease (GD) is the most common cause of pediatric hyperthyroidism, and if untreated, may result in multisystem complications and decreased quality of life. Through a multifaceted quality improvement (QI) approach, we aimed to address treatment barriers after a new diagnosis of GD and increase the percentage of patients attaining an euthyroid state within 3 months from diagnosis and sustain for 12 months. METHODS: Using standard QI methodologies from January to November 2023, our plan, do, study, act cycles focused on an educational handout and checklist at diagnosis, a standardized methimazole dose based on initial free thyroxine (T4) and age, and frequent provider check-ins with phone call at 2 weeks, telehealth visit at 4 weeks with laboratories, and continued QI follow-up for 3 months as process measures. Outcome measure was the percentage of patients achieving normalization of free T4 level by 3 months. We used an electronic dashboard to track patients. RESULTS: Of the 46 patients, 76% (34) received written education; 67% (30) were initiated on standardized methimazole dosing; 80% (37) and 70% (32), respectively, attended the 2-week telephone and 1-month telehealth visits, and 83% (38) obtained 1-month laboratories. By 3 months, the outcome measure increased to 78% (36/46) from 47% (15/32) (P < 0.01), sustained at 6 months (58% versus 22%) but decreased by 12 months (45% versus 40%). Barriers included missed appointments/laboratories, language, medication adherence, and/or lack of insurance. CONCLUSIONS: Through a multifaceted QI approach, we increased the percentage of newly diagnosed GD patients with normal free T4 levels and sustained for 6 months. Extension of follow-up is planned.

APA Citation

Alkhatib, Einas H.; Patel, Tejal; Harlam, Julie; Pavuluri, Padmaja; Naveed, Maria; Dauber, Andrew; and Vaidyanathan, Priya, "Improvement of Free T4 in Newly Diagnosed Graves Disease Patients Through a Multifaceted Quality Improvement Approach" (2025). GW Authored Works. Paper 7346.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7346

Department

Pediatrics