J Pediatr. 2020 Jan;216:32-36.e2. doi: 10.1016/j.jpeds.2019.09.071. Epub 2019 Nov 6.

Brandon Sparks ¹, Salman Salman ², Mary Shull ³, Anne Trout ², Ashley Kiel ², Ivor Hill ², Tracy Ediger ², Brendan Boyle ²

Author information

• ¹Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children at IU Health, Indianapolis, IN. Electronic address: bsparks5@iuhealth.org.
• ²Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH.
• ³Digestive Health Institute, Children's Hospital Colorado, Denver, CO.

Abstract

Objectives: 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.

Study design: 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.

Results: 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.

Conclusions: 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.