Abstract

Background and Aims

Dedicated multidisciplinary programs in gastroenterology are emerging with the goal to improve care. There is little information about the effects of a celiac disease program on disease-related quality care metrics and outcomes. We aimed to compare quality care metrics, symptom resolution, and serological response among patients diagnosed and treated in a celiac disease program with a standard of care cohort.

Methods

We performed a retrospective cohort study with adult celiac disease patients. We divided patients into two groups: celiac disease patients treated in our program and those treated by gastroenterologists not affiliated with the program (standard of care). We abstracted data from electronical medical records and compared frequency at which guideline-driven quality care metrics were obtained, assessed symptom resolution, and serological response based on IgA anti-tissue transglutaminase levels.

Results

We included 340 patients, 120 in the celiac disease program (89 women) and 220 (166 women) in the standard of care. Frequency of quality care metrics implementation in program patients was significantly greater for all variables (p < 0.0005). Diarrhea resolved in 38/46 (82.6%) in the CD program and 63/98 (64.2%) in the standard of care after starting a gluten-free diet (p = .025); bloating also resolved significantly more often in the former (26/34) than the latter (31/58; p = 0.03). Otherwise, there were no significant differences in resolution of clinical symptoms or serological response.

Conclusion

A celiac disease program improves celiac-related quality care metrics and may improve outcomes such as diarrhea resolution compared to standard of care.

中文翻译：

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专门的乳糜泻计划可改善乳糜泻质量护理指标和现实生活中的短期结果

摘要

背景和目标

专门的胃肠病学多学科项目正在兴起，其目标是改善护理。关于乳糜泻计划对疾病相关的质量护理指标和结果的影响的信息很少。我们的目的是将乳糜泻项目中诊断和治疗的患者的质量护理指标、症状缓解和血清学反应与标准护理队列进行比较。

方法

我们对成年乳糜泻患者进行了一项回顾性队列研究。我们将患者分为两组：在我们的计划中接受治疗的乳糜泻患者和由不属于该计划（护理标准）的胃肠病学家治疗的患者。我们从电子病历中提取数据，比较获得指南驱动的质量护理指标的频率，评估症状的缓解情况，以及基于 IgA 抗组织转谷氨酰胺酶水平的血清学反应。

结果

我们纳入了 340 名患者，其中 120 名患者接受乳糜泻项目（89 名女性），220 名患者（166 名女性）接受标准护理。对于所有变量，项目患者实施质量护理指标的频率均显着更高 ( p  < 0.0005)。开始无麸质饮食后，CD 计划中 38/46 (82.6%) 的腹泻得到缓解，标准护理中 63/98 (64.2%) 的腹泻得到缓解 ( p  = .025)；前者（26/34）比后者（31/58；p  = 0.03）更容易解决腹胀。除此之外，临床症状或血清学反应的缓解没有显着差异。

结论

与标准护理相比，乳糜泻计划可改善乳糜泻相关的质量护理指标，并可能改善腹泻缓解等结果。