Explanatory Sequential Mixed-Methods Study of the Effectiveness of the Childhood Dysphagia Management Scale (CDMS): Part 2 of a CDMS Hybrid Effectiveness-Implementation Study.

PURPOSE: As Part 2 of a Type 1 hybrid effectiveness-implementation study, we evaluated the effectiveness of the Childhood Dysphagia Management Scale (CDMS), a validated pediatric dysphagia outcomes assessment completed by therapists following instrumental swallow assessments. METHOD: Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance and Consolidated Framework for Implementation Research implementation science frameworks, mixed methods were used to evaluate CDMS effectiveness in a tertiary care children's hospital system across the following areas: general/workflow, referrals, follow-up care, communication, and patient/caregiver impact. Using an explanatory sequential design, quantitative results informed qualitative interview guides. Referrals for and receipt of dysphagia management follow-up care were evaluated for patients seen pre-CDMS implementation (n = 533) and post-CDMS implementation (n = 594). Separate analyses were conducted for patients with Down syndrome. Results were modeled via ordinal logistic regression across patient-level and contextual factors. Surveys and interviews were conducted with referring providers (n = 17) and therapists (n = 35) to explore knowledge gaps revealed in the quantitative analysis. Qualitative data were analyzed using rapid qualitative analysis and integrated with quantitative data. RESULTS: Pre- to post-CDMS implementation, referrals (28.7%-73.6%, p < .001) and receipt of follow-up care (57%-63%, p = .067) increased. Patients had 9.8 (7.31-13.29) times greater odds of referrals matching their CDMS score post-implementation (p < .001). Patients with Down syndrome had higher CDMS scores and follow-up care needs. Interviews revealed critical insights about mechanisms involved in the CDMS workflow that supported the observed improvements in referrals and follow-up care and also brought areas of challenge for dysphagia management care to light such as access, process dissemination, risk for service duplication, and family burden. CONCLUSIONS: Implementing the CDMS and its associated workflow in a large children's hospital system provided an objective process that increased frequency of referrals and improved follow-up care for dysphagia management. Qualitative inquiry illuminated mechanisms, barriers, and facilitators. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.33180143.