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The impact of education and clinical decision support on the quality of positive antinuclear antibody referrals

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Abstract

To implement and evaluate an intervention using education and clinical decision support (CDS) to improve the quality of positive ANA referrals. We retrospectively reviewed “positive ANA” referrals from April 2017 to May 2019. Demographic data and referring provider’s location were recorded. Final diagnoses were categorized into two groups: rheumatic disease (RD) or no RD. We compared pre- and post-intervention groups for each type of referral. The positive predictive value (PPV) of an ANA referral leading to an RD for each referral group was calculated. Our intervention consisted of an educational poster and CDS which included a hard-stop prompt embedded into the electronic ANA order. All internal subgroups received CDS; only the main campus primary care providers (IPCP) received the educational poster. The external (EXT) referral subgroup did not receive either intervention. We found a significant increase in the number of RDs diagnosed post-intervention (p = 0.007). The PPV for all referrals increased from 16% to 26% during this project. All groups demonstrated improvement in PPV except the EXT group, which showed no change. Subgroups which demonstrated significant increase in the diagnosis of RD included total internal (p = 0.0005), internal PCP (p = 0.002), and affiliated primary care providers (p = 0.0002). The IPCP subgroup additionally received the educational intervention and did not demonstrate significant improvement. Implementing an intervention with a CDS component helps improve the quality of positive ANA referrals to rheumatology.

Key Points

• Clinical decision support improves the quality of positive ANA referrals.

• Incorporating clinical decision support within the ANA order of an EHR is an effective way to deliver information to impact ordering at the “point of care.”

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Fig. 1

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to this work being designated as quality improvement but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Medicine, Division of Rheumatology, University of Texas at Austin, Dell Medical School, Health Discovery Building 7.802, 1601 Trinity St, Bldg B, Z0900, Austin, TX, 78712, USA

    Veena Patel

  2. Department of Medicine, Section of Rheumatology, University of Chicago, Chicago, IL, USA

    Kichul Ko

  3. Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Anisha B. Dua

Authors
  1. Veena Patel
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  2. Kichul Ko
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  3. Anisha B. Dua
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Contributions

• Veena Patel—contributed to the conception of the work, acquisition of data, data analysis, drafted the work and approved submitted version and revisions

• Kichul Ko—contributed to the conception of the work, interpretation of the data, substantially revised it, and approved submitted version and revisions

• Anisha Dua—contributed to the conception of the work, interpretation of the data, substantially revised it, and approved submitted version and revisions

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Correspondence to Veena Patel.

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Preliminary data was published as a conference abstract:

Patel V, Dua A. The Utility of Positive ANA Referrals at the University of Chicago [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/the-utility-of-positive-ana-referrals-at-the-university-of-chicago/. Accessed November 11, 2020.

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Patel, V., Ko, K. & Dua, A.B. The impact of education and clinical decision support on the quality of positive antinuclear antibody referrals. Clin Rheumatol 40, 2921–2925 (2021). https://doi.org/10.1007/s10067-021-05594-x

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  • DOI: https://doi.org/10.1007/s10067-021-05594-x

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