Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children at IU Health, Indianapolis, IN.
Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH.
J Pediatr. 2020 Jan;216:32-36.e2. doi: 10.1016/j.jpeds.2019.09.071. Epub 2019 Nov 6.
To describe quality improvement efforts to reduce variability in the care of children diagnosed with celiac disease through use of an institutional patient registry and a chronic care index.
An institutional patient registry tracked rates of follow-up visits and repeat serologic testing. A Celiac Care Index that included anthropometrics, biopsy expectations, dietician consultation, and baseline laboratory evaluation was developed to standardize evaluation at diagnosis. Provider education sessions communicated expectations for this standard of care and order sets within the electronic medical record simplified test collection. Data was recorded and reviewed weekly and structured communications with providers were provided biweekly.
Adherence with follow-up expectations (77%-89% P = .03) and repeat serologic testing (50%-90% P < .0001) significantly increased during the study period. Adherence with completion of the Celiac Care Index resulted in significant improvement in obtaining complete blood count (80%-98% P < .0001), iron (25%-78% P < .0001), ferritin (34%-80% P < .0001), alanine aminotransferase/aspartate aminotransferase (74%-96% P < .0001), thyroid-stimulating hormone (64%-90% P < .0001), vitamin D (36%-83% P < .0001), and hepatitis B immune status (30%-80% P < .0001). Iron deficiency demonstrated by low ferritin levels was common (41%) and a high rate of nonimmunity to hepatitis B (70%) was detected.
The Celiac Care Index improved adherence with published care recommendations and reduced variability in baseline evaluation at diagnosis. Laboratory test results indicate further studies are needed to evaluate these recommendations.
通过使用机构患者登记处和慢性病护理指数，描述减少儿童乳糜泻护理变异性的质量改进工作。
机构患者登记处跟踪随访就诊和重复血清学检测的比例。制定了乳糜泻护理指数，包括人体测量学、活检预期、营养师咨询和基线实验室评估，以规范诊断时的评估。医疗提供者教育课程传达了这种护理标准的预期，并简化了电子病历中的医嘱集以进行测试收集。每周记录和审查数据，并与提供者进行定期沟通。
在研究期间，随访预期（77%-89%，P=0.03）和重复血清学检测（50%-90%，P<.0001）的依从性显著提高。完成乳糜泻护理指数后，全血细胞计数（80%-98%，P<.0001）、铁（25%-78%，P<.0001）、铁蛋白（34%-80%，P<.0001）、丙氨酸氨基转移酶/天冬氨酸氨基转移酶（74%-96%，P<.0001）、促甲状腺激素（64%-90%，P<.0001）、维生素 D（36%-83%，P<.0001）和乙型肝炎免疫状态（30%-80%，P<.0001）的获得显著改善。低铁蛋白水平表明铁缺乏症很常见（41%），乙型肝炎非免疫力率很高（70%）。
乳糜泻护理指数提高了对已发表护理建议的依从性，并减少了诊断时基线评估的变异性。实验室检测结果表明，需要进一步研究来评估这些建议。
