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STANDARDIZATION AND IMPROVEMENT IN PEDIATRIC CELIAC CARE

Background Literature describing practitioner adherence with guidelines for follow up care in patients diagnosed with celiac disease (CD) is limited. NASPGHAN CD guidelines recommend all newly diagnosed patients have repeat serology testing 6 months after diagnosis. Adherence with these recommendations has not been previously described. Objectives To review institutional adherence with national guidelines for patients newly diagnosed with celiac disease. We aimed to increase the percentage of patients having repeat serology testing within 9 months of diagnosis from a baseline of 54% to 90% by December 2015. Methods Key drivers to improvement included the creation of a reliable, tracking registry and the implementation of a local standard of care. The celiac QI team outlined these divisional expectations through practitioner educational sessions and reporting of practitioner adherence with national guidelines. Improved utilization of administrative staff systematically identified cohorts of patients in need of follow up visits and testing. Results Baseline data showed the percentage with repeat testing within 9 months of diagnosis was 54.8% (Q4 2009–Q4 2012). Standardizing care and tracking outcomes increased this percentage to 72.8% (Q1 2013–Q2 2015)-p=0.000. The percentage of patients with a follow up clinic visit within 9 months of diagnosis has increased from a baseline percentage of 82.2% (Q4 2012–Q4 2013) to our current percentage of 96.6% (Q1 2014–Q2 2015)-p=0.000. Conclusions Targeted communication with practitioners and families after development of a CD patient registry at our institution allowed structured data capture and significantly improved institutional adherence with national guidelines. Figure 1 Percentage of patients with serology testing within 9 months of diagnosis. Figure 2 Percentage of patients with a follow-up GI visit within 9 months of diagnosis.