Course Goals

The goal of this EQIPP GER or GERD? Diagnosis and Management course is to help you create plans for improvement and to address gaps identified in key activities of clinical care related to the identification and management of children with gastroesophageal reflux. These activities focus on improving ongoing medical care and patient/family education and support. You will collect baseline and follow-up data as you work to improve care and processes through Plan, Do, Study, and Act (PDSA) cycles.

Learning Objectives

By the end of this course, you will:

• Be familiar with the following guidelines and recommendations:
  • 2009 Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of NASPGHAN and ESPGHAN  
  • A Global, Evidence-Based Consensus on the Definition of Gastroesophageal Reflux Disease in the Pediatric Population  
  • Performing Preventive Service: Physical Examination.
  • AAP 2013 Clinical Report, Gastroesophageal Reflux: Management Guidance for the Pediatrician
• Recognize how the key activities identified in this course contribute to high-quality, ongoing care of all patients identified with reflux conditions. 
• Be able to implement ideas for change to help you do the following:
  • Demonstrate an accurate diagnosis of GERD.
  • Know the symptoms and signs consistent with GERD.
  • Recognize warning signals that may indicate another diagnosis, which may underlie the presenting symptom of reflux or vomiting.
  • Discern a “true GERD diagnosis” from a “GERD masquerader.”
  • Know when to order diagnostic tests and when not to.
  • Know when and what lifestyle modifications should be recommended.
  • Understand when acid suppression medications or other treatments should be initiated or discontinued.
  • Know when to appropriately refer a patient to a pediatric gastroenterologist. 
  • Be familiar with what information should be sent to the referring gastroenterologist. 
  • Know how to provide anticipatory guidance for gastroesophageal reflux.
  • Be comfortable with educating patients and caregivers and where to get educational materials to help patients better understand GER and GERD. 
  • Create a follow-up plan for patients with gastroesophageal reflux.
  • Create (gastroenerologist) or obtain (pediatrician) a written care plan for patients with GERD.
  • Establish processes for regular, ongoing communication among care team members that identifies team members, facilitates effective referrals, and provides timely updates on the patient’s care plan and health status.
• Measure and improve care delivery and processes for the above key activities by doing the following:
  • Collect and analyze baseline data to establish a starting point for improvement.
  • Identify one or more performance gaps in key activities of gastroesophageal reflux care.
  • Create an improvement plan for closing identified performance gap(s) and document the improvement idea to be tested:
    • AIM: What are we trying to improve or accomplish?
    • MEASURES: How will we know that a change made is an improvement?
    • CHANGES: What changes can we make that will result in improvement?
  • Test ideas quickly on a small scale to determine if the changes lead to improvement.
  • Collect and analyze follow-up data to measure the results of the test. (A minimum of two follow-up data collection cycles are necessary for course completion and maintenance of certification recognition).
  • Determine how to sustain successful changes and how to systematically integrate them into the culture, processes, and workflow of your practice.
  • Create additional improvement plans and repeat PDSA cycles until you reach the maximum potential of providing optimal gastroesophageal reflux care in your practice.