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