title: Improving serological test ordering patterns for the diagnosis of celiac disease through clinical laboratory audit of practice.
abstract: BACKGROUND
  Clinical Practice Guidelines (CPG) from both adult medicine and pediatrics recommend tTG to screen for celiac disease (CD).
  
  
  METHODS
  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.
  
  
  RESULTS
  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)).
  
  
  CONCLUSIONS
  The audit reduced the CPG-practice gap that existed in the screening of CD.
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1.
authors.forename: Yun
authors.initials: Y
authors.lastname: Huang
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Don-Wauchope
authors.forename: Vijay L
authors.initials: VL
authors.lastname: Grey
authors.forename: Maged
authors.initials: M
authors.lastname: Mansour
authors.forename: Herbert
authors.initials: H
authors.lastname: Brill
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D002648:Child; D054869:Clinical Audit; D019983:Guideline Adherence; D006801:Humans; D010820:Physicians; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012698:Serologic Tests / Q000706:statistics & numerical data*