Network implementation of guideline for early detection decreases age at cerebral palsy diagnosis

Nathalie L. Maitre, Vera J. Burton, Andrea F. Duncan, Sai Iyer, Betsy Ostrander, Sarah Winter, Lauren Ayala, Stephanie Burkhardt, Gwendolyn Gerner, Ruth Getachew, Kelsey Jiang, Laurie Lesher, Carrie M. Perez, Melissa Moore-Clingenpeel, Rebecca Lam, Dennis J. Lewandowski, Rachel Byrne

Research output: Contribution to journalArticlepeer-review


BACKGROUND AND OBJECTIVES: Early diagnosis of cerebral palsy (CP) is critical in obtaining evidence-based interventions when plasticity is greatest. In 2017, international guidelines for early detection of CP were published on the basis of a systematic review of evidence. Our study aim was to reduce the age at CP diagnosis throughout a network of 5 diverse US high-risk infant follow-up programs through consistent implementation of these guidelines. METHODS: The study leveraged plan-do-study-act and Lean methodologies. The primary outcome was age at CP diagnosis. Data were acquired during the corresponding 9-month baseline and quarterly throughout study. Balancing measures were clinic no-show rates and parent perception of the diagnosis visit. Clinic teams conducted strengths, weaknesses, opportunities, and threats analyses, process flow evaluations, standardized assessments training, and parent questionnaires. Performance of a 3- to 4-month clinic visit was a critical process step because it included a Hammersmith Infant Neurologic Examination, a General Movements Assessment, and standardized assessments of motor function. RESULTS: The age at CP diagnosis decreased from a weighted average of 19.5 (95% confidence interval 16.2 to 22.8) to 9.5 months (95% confidence interval 4.5 to 14.6), with P = .008; 3- to 4-month visits per site increased from the median (interquartile range) 14 (5.2–73.7) to 54 (34.5–152.0), with P, .001; and no-show rates were not different. Parent questionnaires revealed positive provider perception with improvement opportunities for information content and understandability. CONCLUSIONS: Large-scale implementation of international guidelines for early detection of CP is feasible in diverse high-risk infant follow-up clinics. The initiative was received positively by families and without adversely affecting clinic operational flow. Additional parent support and education are necessary.

Original languageEnglish (US)
Article numbere20192126
Issue number5
StatePublished - May 2020

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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