Improving serological test ordering patterns for the diagnosis of celiac disease through clinical laboratory audit of practice
Clinical Practice Guidelines (CPG) from both adult medicine and pediatrics recommend tTG to screen for celiac disease (CD). Serological test orders for celiac disease were evaluated against the guidelines. Ordering physicians were categorized as gastroenterologists, immunologists, pediatricians, oth...
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| Veröffentlicht in: | Clinical biochemistry 2012-04, Vol.45 (6), p.455-459 |
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| creator | Huang, Yun Don-Wauchope, Andrew C. Grey, Vijay L. Mansour, Maged Brill, Herbert Armstrong, David |
| description | Clinical Practice Guidelines (CPG) from both adult medicine and pediatrics recommend tTG to screen for celiac disease (CD).
Serological test orders for celiac disease were evaluated against the guidelines. Ordering physicians were categorized as gastroenterologists, immunologists, pediatricians, other hospital physicians and non-hospital physicians. Interventions based on initial audit were implemented, including interacting with physicians, revising test menu and changing test ordering policy. After implementation of interventions, test orders were re-evaluated.
After corrective interventions celiac panel (CP) orders were decreased from 48.4% to 3.6% in children, and from 72.3% to 28.1% in adults. Physicians ordered tTG alone for more than 90% of children. In adults the ordering of tTG alone was significantly increased from 7.2% to 61.3% (from 8.9% to 63.9% for gastroenterologists and from 8.1% to 44.4% for other physicians (p |
| doi_str_mv | 10.1016/j.clinbiochem.2012.01.007 |
| format | Article |
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Serological test orders for celiac disease were evaluated against the guidelines. Ordering physicians were categorized as gastroenterologists, immunologists, pediatricians, other hospital physicians and non-hospital physicians. Interventions based on initial audit were implemented, including interacting with physicians, revising test menu and changing test ordering policy. After implementation of interventions, test orders were re-evaluated.
After corrective interventions celiac panel (CP) orders were decreased from 48.4% to 3.6% in children, and from 72.3% to 28.1% in adults. Physicians ordered tTG alone for more than 90% of children. In adults the ordering of tTG alone was significantly increased from 7.2% to 61.3% (from 8.9% to 63.9% for gastroenterologists and from 8.1% to 44.4% for other physicians (p<0.05)).
The audit reduced the CPG-practice gap that existed in the screening of CD.
► Clinical audit can successfully contribute to change in laboratory orders. ► Laboratory staff must be proactive in introducing best practice as defined by CPG. ► Celiac disease testing needs to be revised if gliadin tests are still offered.</description><identifier>ISSN: 0009-9120</identifier><identifier>EISSN: 1873-2933</identifier><identifier>DOI: 10.1016/j.clinbiochem.2012.01.007</identifier><identifier>PMID: 22285379</identifier><language>eng</language><publisher>Amsterdam: Elsevier Inc</publisher><subject>Adult ; Biological and medical sciences ; Celiac disease ; Celiac Disease - blood ; Celiac Disease - diagnosis ; Celiac Disease - immunology ; Child ; Clinical Audit ; Gastroenterology. Liver. Pancreas. Abdomen ; Gliadin ; Guideline Adherence ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Medical sciences ; Other diseases. Semiology ; Physicians ; Practice Guidelines as Topic ; Quality Assurance, Health Care ; Quality Improvement ; Serologic Tests - utilization ; Serology ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Tissue transglutaminase</subject><ispartof>Clinical biochemistry, 2012-04, Vol.45 (6), p.455-459</ispartof><rights>2012 The Canadian Society of Clinical Chemists</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 The Canadian Society of Clinical Chemists. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c406t-83353742b7fb3a51b454d3667fa4d7ea0d1d11ab822e81ed1c8d3425191abe713</citedby><cites>FETCH-LOGICAL-c406t-83353742b7fb3a51b454d3667fa4d7ea0d1d11ab822e81ed1c8d3425191abe713</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.clinbiochem.2012.01.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25785292$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22285379$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huang, Yun</creatorcontrib><creatorcontrib>Don-Wauchope, Andrew C.</creatorcontrib><creatorcontrib>Grey, Vijay L.</creatorcontrib><creatorcontrib>Mansour, Maged</creatorcontrib><creatorcontrib>Brill, Herbert</creatorcontrib><creatorcontrib>Armstrong, David</creatorcontrib><title>Improving serological test ordering patterns for the diagnosis of celiac disease through clinical laboratory audit of practice</title><title>Clinical biochemistry</title><addtitle>Clin Biochem</addtitle><description>Clinical Practice Guidelines (CPG) from both adult medicine and pediatrics recommend tTG to screen for celiac disease (CD).
Serological test orders for celiac disease were evaluated against the guidelines. Ordering physicians were categorized as gastroenterologists, immunologists, pediatricians, other hospital physicians and non-hospital physicians. Interventions based on initial audit were implemented, including interacting with physicians, revising test menu and changing test ordering policy. After implementation of interventions, test orders were re-evaluated.
After corrective interventions celiac panel (CP) orders were decreased from 48.4% to 3.6% in children, and from 72.3% to 28.1% in adults. Physicians ordered tTG alone for more than 90% of children. In adults the ordering of tTG alone was significantly increased from 7.2% to 61.3% (from 8.9% to 63.9% for gastroenterologists and from 8.1% to 44.4% for other physicians (p<0.05)).
The audit reduced the CPG-practice gap that existed in the screening of CD.
► Clinical audit can successfully contribute to change in laboratory orders. ► Laboratory staff must be proactive in introducing best practice as defined by CPG. ► Celiac disease testing needs to be revised if gliadin tests are still offered.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Celiac disease</subject><subject>Celiac Disease - blood</subject><subject>Celiac Disease - diagnosis</subject><subject>Celiac Disease - immunology</subject><subject>Child</subject><subject>Clinical Audit</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Gliadin</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Medical sciences</subject><subject>Other diseases. Semiology</subject><subject>Physicians</subject><subject>Practice Guidelines as Topic</subject><subject>Quality Assurance, Health Care</subject><subject>Quality Improvement</subject><subject>Serologic Tests - utilization</subject><subject>Serology</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Tissue transglutaminase</subject><issn>0009-9120</issn><issn>1873-2933</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkE1v3CAQhlHVqNmm_QsVPVQ92WHAXxyrVdpEitRLekYYxrusbLMFHCmX_Pbi7Pbj2BOCeWZ45yHkI7ASGDTXh9KMbu6dN3ucSs6AlwxKxtpXZANdKwouhXhNNowxWUjg7JK8jfGQr7zqmjfkknPe1aKVG_J8Nx2Df3TzjkYMfvQ7Z_RIE8ZEfbAY1spRp4RhjnTwgaY9Uuv0bvbRReoHanB02uS3iDpirge_7PZ0jfgya9S9Dzr58ET1Yl1ae45Bm-QMviMXgx4jvj-fV-TH15uH7W1x__3b3fbLfWEq1qSiEyLHrXjfDr3QNfRVXVnRNO2gK9uiZhYsgO47zrEDtGA6Kypeg8yP2IK4Ip9Pc_OyP5e8nJpczMFHPaNfopJcAshatpmUJ9IEH2PAQR2Dm3R4UsDUal8d1D_21WpfMVDZfu79cP5l6Se0fzp_687ApzOgY1YzBD0bF_9yddvVXPLMbU8cZiePDoOKxuFs0LqAJinr3X_E-QXBLKuZ</recordid><startdate>20120401</startdate><enddate>20120401</enddate><creator>Huang, Yun</creator><creator>Don-Wauchope, Andrew C.</creator><creator>Grey, Vijay L.</creator><creator>Mansour, Maged</creator><creator>Brill, Herbert</creator><creator>Armstrong, David</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120401</creationdate><title>Improving serological test ordering patterns for the diagnosis of celiac disease through clinical laboratory audit of practice</title><author>Huang, Yun ; Don-Wauchope, Andrew C. ; Grey, Vijay L. ; Mansour, Maged ; Brill, Herbert ; Armstrong, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c406t-83353742b7fb3a51b454d3667fa4d7ea0d1d11ab822e81ed1c8d3425191abe713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Celiac disease</topic><topic>Celiac Disease - blood</topic><topic>Celiac Disease - diagnosis</topic><topic>Celiac Disease - immunology</topic><topic>Child</topic><topic>Clinical Audit</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Gliadin</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Medical sciences</topic><topic>Other diseases. Semiology</topic><topic>Physicians</topic><topic>Practice Guidelines as Topic</topic><topic>Quality Assurance, Health Care</topic><topic>Quality Improvement</topic><topic>Serologic Tests - utilization</topic><topic>Serology</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Tissue transglutaminase</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huang, Yun</creatorcontrib><creatorcontrib>Don-Wauchope, Andrew C.</creatorcontrib><creatorcontrib>Grey, Vijay L.</creatorcontrib><creatorcontrib>Mansour, Maged</creatorcontrib><creatorcontrib>Brill, Herbert</creatorcontrib><creatorcontrib>Armstrong, David</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical biochemistry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huang, Yun</au><au>Don-Wauchope, Andrew C.</au><au>Grey, Vijay L.</au><au>Mansour, Maged</au><au>Brill, Herbert</au><au>Armstrong, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improving serological test ordering patterns for the diagnosis of celiac disease through clinical laboratory audit of practice</atitle><jtitle>Clinical biochemistry</jtitle><addtitle>Clin Biochem</addtitle><date>2012-04-01</date><risdate>2012</risdate><volume>45</volume><issue>6</issue><spage>455</spage><epage>459</epage><pages>455-459</pages><issn>0009-9120</issn><eissn>1873-2933</eissn><abstract>Clinical Practice Guidelines (CPG) from both adult medicine and pediatrics recommend tTG to screen for celiac disease (CD).
Serological test orders for celiac disease were evaluated against the guidelines. Ordering physicians were categorized as gastroenterologists, immunologists, pediatricians, other hospital physicians and non-hospital physicians. Interventions based on initial audit were implemented, including interacting with physicians, revising test menu and changing test ordering policy. After implementation of interventions, test orders were re-evaluated.
After corrective interventions celiac panel (CP) orders were decreased from 48.4% to 3.6% in children, and from 72.3% to 28.1% in adults. Physicians ordered tTG alone for more than 90% of children. In adults the ordering of tTG alone was significantly increased from 7.2% to 61.3% (from 8.9% to 63.9% for gastroenterologists and from 8.1% to 44.4% for other physicians (p<0.05)).
The audit reduced the CPG-practice gap that existed in the screening of CD.
► Clinical audit can successfully contribute to change in laboratory orders. ► Laboratory staff must be proactive in introducing best practice as defined by CPG. ► Celiac disease testing needs to be revised if gliadin tests are still offered.</abstract><cop>Amsterdam</cop><pub>Elsevier Inc</pub><pmid>22285379</pmid><doi>10.1016/j.clinbiochem.2012.01.007</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Biological and medical sciences Celiac disease Celiac Disease - blood Celiac Disease - diagnosis Celiac Disease - immunology Child Clinical Audit Gastroenterology. Liver. Pancreas. Abdomen Gliadin Guideline Adherence Humans Investigative techniques, diagnostic techniques (general aspects) Medical sciences Other diseases. Semiology Physicians Practice Guidelines as Topic Quality Assurance, Health Care Quality Improvement Serologic Tests - utilization Serology Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Tissue transglutaminase |
| title | Improving serological test ordering patterns for the diagnosis of celiac disease through clinical laboratory audit of practice |
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