Loading…
Choosing Wisely in Daily Practice: An Intervention Study on Antinuclear Antibody Testing by Rheumatologists
Objective To assess the effect of a simple intervention on antinuclear antibody (ANA) test overuse by rheumatologists. Methods This was an explorative, pragmatic, before‐and‐after, controlled implementation study among rheumatologists working at 3 rheumatology departments in secondary and tertiary c...
Saved in:
| Published in: | Arthritis care & research (2010) 2016-04, Vol.68 (4), p.562-569 |
|---|---|
| Main Authors: | , , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c4485-f42c08126563a809fd69c3dd3d49bb73d0b3064fc44b67a898517873856ef6bd3 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c4485-f42c08126563a809fd69c3dd3d49bb73d0b3064fc44b67a898517873856ef6bd3 |
| container_end_page | 569 |
| container_issue | 4 |
| container_start_page | 562 |
| container_title | Arthritis care & research (2010) |
| container_volume | 68 |
| creator | Lesuis, Nienke Hulscher, Marlies E. J. L. Piek, Ester Demirel, Hatice van der Laan‐Baalbergen, Nicole Meek, Inger van Vollenhoven, Ronald F. den Broeder, Alfons A. |
| description | Objective
To assess the effect of a simple intervention on antinuclear antibody (ANA) test overuse by rheumatologists.
Methods
This was an explorative, pragmatic, before‐and‐after, controlled implementation study among rheumatologists working at 3 rheumatology departments in secondary and tertiary care centers in The Netherlands. The intervention was given in all study centers separately and combined education with feedback. Six outcome measures describe the intervention effects: the ANA/new patient ratio (APR), difference with the target APR, percentage of positive ANA tests, percentage of repeated ANA testing, percentage of ANA‐associated diseases, and APR variation between rheumatologists. Outcomes were compared between the pre‐ and postintervention period (both 12 months) using (multilevel) logistic regression or F testing. Results are reported together for centers 1 and 2, and separately for center 3, because ANA tests could not be linked to an individual rheumatologist in center 3.
Results
The APR decreased from 0.37 to 0.11 after the intervention in centers 1 and 2 (odds ratio [OR] 0.19, 95% confidence interval [95% CI] 0.17–0.22, P < 0.001) and from 0.45 to 0.30 in center 3 (OR 0.53, 95% CI 0.45–0.62, P < 0.001). The percentage of repeated ANA requests in all centers and the APR variation for centers 1 and 2 decreased significantly. Only in center 3 did the percentage of ANA‐associated diseases increase significantly.
Conclusion
A simple intervention resulted in a relevant and significant decrease in the numbers of ANA tests requested by rheumatologists, together with an improvement on 3 other outcome measures. |
| doi_str_mv | 10.1002/acr.22725 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_510400</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1776094371</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4485-f42c08126563a809fd69c3dd3d49bb73d0b3064fc44b67a898517873856ef6bd3</originalsourceid><addsrcrecordid>eNp1kctO3DAYha2qVUGUBS9QZdkuAr7b6W40pQUJqYiLYGf5FnDJxFM7AeXtMWSYrvDGx7--cyz7AHCA4CGCEB9pmw4xFph9ALsYMVRTzuTHraa3O2A_57-wLIKlJM1nsIM5RRRCuQselvcx5tDfVTch-26qQl_91KGI86TtEKz_US366rQffHr0_RBiX10Oo5uqIhbl3I-28zq9ahPL_Mrn4SXPTNXFvR9XeohdvAt5yF_Ap1Z32e9v9j1w_ev4anlSn_35fbpcnNWWUsnqlmILJcKccaIlbFrHG0ucI442xgjioCGQ07bQhgstG8mQkIJIxn3LjSN7oJ5z85Nfj0atU1jpNKmog9qMHoryiiFYfqHwzbv8OkX33_RmRIQIwqTkxftt9hbw31ierlYhW991uvdxzAoJwWFDiUAF_T6jNsWck2-3FyGoXqpUpUr1WmVhv25iR7Pybku-FVeAoxl4Cp2f3k9Si-XFHPkMWIypVQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1776094371</pqid></control><display><type>article</type><title>Choosing Wisely in Daily Practice: An Intervention Study on Antinuclear Antibody Testing by Rheumatologists</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Lesuis, Nienke ; Hulscher, Marlies E. J. L. ; Piek, Ester ; Demirel, Hatice ; van der Laan‐Baalbergen, Nicole ; Meek, Inger ; van Vollenhoven, Ronald F. ; den Broeder, Alfons A.</creator><creatorcontrib>Lesuis, Nienke ; Hulscher, Marlies E. J. L. ; Piek, Ester ; Demirel, Hatice ; van der Laan‐Baalbergen, Nicole ; Meek, Inger ; van Vollenhoven, Ronald F. ; den Broeder, Alfons A.</creatorcontrib><description>Objective
To assess the effect of a simple intervention on antinuclear antibody (ANA) test overuse by rheumatologists.
Methods
This was an explorative, pragmatic, before‐and‐after, controlled implementation study among rheumatologists working at 3 rheumatology departments in secondary and tertiary care centers in The Netherlands. The intervention was given in all study centers separately and combined education with feedback. Six outcome measures describe the intervention effects: the ANA/new patient ratio (APR), difference with the target APR, percentage of positive ANA tests, percentage of repeated ANA testing, percentage of ANA‐associated diseases, and APR variation between rheumatologists. Outcomes were compared between the pre‐ and postintervention period (both 12 months) using (multilevel) logistic regression or F testing. Results are reported together for centers 1 and 2, and separately for center 3, because ANA tests could not be linked to an individual rheumatologist in center 3.
Results
The APR decreased from 0.37 to 0.11 after the intervention in centers 1 and 2 (odds ratio [OR] 0.19, 95% confidence interval [95% CI] 0.17–0.22, P < 0.001) and from 0.45 to 0.30 in center 3 (OR 0.53, 95% CI 0.45–0.62, P < 0.001). The percentage of repeated ANA requests in all centers and the APR variation for centers 1 and 2 decreased significantly. Only in center 3 did the percentage of ANA‐associated diseases increase significantly.
Conclusion
A simple intervention resulted in a relevant and significant decrease in the numbers of ANA tests requested by rheumatologists, together with an improvement on 3 other outcome measures.</description><identifier>ISSN: 2151-464X</identifier><identifier>ISSN: 2151-4658</identifier><identifier>EISSN: 2151-4658</identifier><identifier>DOI: 10.1002/acr.22725</identifier><identifier>PMID: 26414008</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Antibodies, Antinuclear - blood ; Biomarkers - blood ; Choice Behavior ; Female ; Humans ; Logistic Models ; Male ; Medical Overuse - prevention & control ; Medicin och hälsovetenskap ; Middle Aged ; Multivariate Analysis ; Netherlands ; Odds Ratio ; Practice Patterns, Physicians ; Predictive Value of Tests ; Rheumatology - methods ; Serologic Tests - utilization</subject><ispartof>Arthritis care & research (2010), 2016-04, Vol.68 (4), p.562-569</ispartof><rights>2016, American College of Rheumatology</rights><rights>2016, American College of Rheumatology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4485-f42c08126563a809fd69c3dd3d49bb73d0b3064fc44b67a898517873856ef6bd3</citedby><cites>FETCH-LOGICAL-c4485-f42c08126563a809fd69c3dd3d49bb73d0b3064fc44b67a898517873856ef6bd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26414008$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:133735886$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Lesuis, Nienke</creatorcontrib><creatorcontrib>Hulscher, Marlies E. J. L.</creatorcontrib><creatorcontrib>Piek, Ester</creatorcontrib><creatorcontrib>Demirel, Hatice</creatorcontrib><creatorcontrib>van der Laan‐Baalbergen, Nicole</creatorcontrib><creatorcontrib>Meek, Inger</creatorcontrib><creatorcontrib>van Vollenhoven, Ronald F.</creatorcontrib><creatorcontrib>den Broeder, Alfons A.</creatorcontrib><title>Choosing Wisely in Daily Practice: An Intervention Study on Antinuclear Antibody Testing by Rheumatologists</title><title>Arthritis care & research (2010)</title><addtitle>Arthritis Care Res (Hoboken)</addtitle><description>Objective
To assess the effect of a simple intervention on antinuclear antibody (ANA) test overuse by rheumatologists.
Methods
This was an explorative, pragmatic, before‐and‐after, controlled implementation study among rheumatologists working at 3 rheumatology departments in secondary and tertiary care centers in The Netherlands. The intervention was given in all study centers separately and combined education with feedback. Six outcome measures describe the intervention effects: the ANA/new patient ratio (APR), difference with the target APR, percentage of positive ANA tests, percentage of repeated ANA testing, percentage of ANA‐associated diseases, and APR variation between rheumatologists. Outcomes were compared between the pre‐ and postintervention period (both 12 months) using (multilevel) logistic regression or F testing. Results are reported together for centers 1 and 2, and separately for center 3, because ANA tests could not be linked to an individual rheumatologist in center 3.
Results
The APR decreased from 0.37 to 0.11 after the intervention in centers 1 and 2 (odds ratio [OR] 0.19, 95% confidence interval [95% CI] 0.17–0.22, P < 0.001) and from 0.45 to 0.30 in center 3 (OR 0.53, 95% CI 0.45–0.62, P < 0.001). The percentage of repeated ANA requests in all centers and the APR variation for centers 1 and 2 decreased significantly. Only in center 3 did the percentage of ANA‐associated diseases increase significantly.
Conclusion
A simple intervention resulted in a relevant and significant decrease in the numbers of ANA tests requested by rheumatologists, together with an improvement on 3 other outcome measures.</description><subject>Adult</subject><subject>Antibodies, Antinuclear - blood</subject><subject>Biomarkers - blood</subject><subject>Choice Behavior</subject><subject>Female</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical Overuse - prevention & control</subject><subject>Medicin och hälsovetenskap</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Netherlands</subject><subject>Odds Ratio</subject><subject>Practice Patterns, Physicians</subject><subject>Predictive Value of Tests</subject><subject>Rheumatology - methods</subject><subject>Serologic Tests - utilization</subject><issn>2151-464X</issn><issn>2151-4658</issn><issn>2151-4658</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNp1kctO3DAYha2qVUGUBS9QZdkuAr7b6W40pQUJqYiLYGf5FnDJxFM7AeXtMWSYrvDGx7--cyz7AHCA4CGCEB9pmw4xFph9ALsYMVRTzuTHraa3O2A_57-wLIKlJM1nsIM5RRRCuQselvcx5tDfVTch-26qQl_91KGI86TtEKz_US366rQffHr0_RBiX10Oo5uqIhbl3I-28zq9ahPL_Mrn4SXPTNXFvR9XeohdvAt5yF_Ap1Z32e9v9j1w_ev4anlSn_35fbpcnNWWUsnqlmILJcKccaIlbFrHG0ucI442xgjioCGQ07bQhgstG8mQkIJIxn3LjSN7oJ5z85Nfj0atU1jpNKmog9qMHoryiiFYfqHwzbv8OkX33_RmRIQIwqTkxftt9hbw31ierlYhW991uvdxzAoJwWFDiUAF_T6jNsWck2-3FyGoXqpUpUr1WmVhv25iR7Pybku-FVeAoxl4Cp2f3k9Si-XFHPkMWIypVQ</recordid><startdate>201604</startdate><enddate>201604</enddate><creator>Lesuis, Nienke</creator><creator>Hulscher, Marlies E. J. L.</creator><creator>Piek, Ester</creator><creator>Demirel, Hatice</creator><creator>van der Laan‐Baalbergen, Nicole</creator><creator>Meek, Inger</creator><creator>van Vollenhoven, Ronald F.</creator><creator>den Broeder, Alfons A.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope></search><sort><creationdate>201604</creationdate><title>Choosing Wisely in Daily Practice: An Intervention Study on Antinuclear Antibody Testing by Rheumatologists</title><author>Lesuis, Nienke ; Hulscher, Marlies E. J. L. ; Piek, Ester ; Demirel, Hatice ; van der Laan‐Baalbergen, Nicole ; Meek, Inger ; van Vollenhoven, Ronald F. ; den Broeder, Alfons A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4485-f42c08126563a809fd69c3dd3d49bb73d0b3064fc44b67a898517873856ef6bd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Antibodies, Antinuclear - blood</topic><topic>Biomarkers - blood</topic><topic>Choice Behavior</topic><topic>Female</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical Overuse - prevention & control</topic><topic>Medicin och hälsovetenskap</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Netherlands</topic><topic>Odds Ratio</topic><topic>Practice Patterns, Physicians</topic><topic>Predictive Value of Tests</topic><topic>Rheumatology - methods</topic><topic>Serologic Tests - utilization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lesuis, Nienke</creatorcontrib><creatorcontrib>Hulscher, Marlies E. J. L.</creatorcontrib><creatorcontrib>Piek, Ester</creatorcontrib><creatorcontrib>Demirel, Hatice</creatorcontrib><creatorcontrib>van der Laan‐Baalbergen, Nicole</creatorcontrib><creatorcontrib>Meek, Inger</creatorcontrib><creatorcontrib>van Vollenhoven, Ronald F.</creatorcontrib><creatorcontrib>den Broeder, Alfons A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><jtitle>Arthritis care & research (2010)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lesuis, Nienke</au><au>Hulscher, Marlies E. J. L.</au><au>Piek, Ester</au><au>Demirel, Hatice</au><au>van der Laan‐Baalbergen, Nicole</au><au>Meek, Inger</au><au>van Vollenhoven, Ronald F.</au><au>den Broeder, Alfons A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Choosing Wisely in Daily Practice: An Intervention Study on Antinuclear Antibody Testing by Rheumatologists</atitle><jtitle>Arthritis care & research (2010)</jtitle><addtitle>Arthritis Care Res (Hoboken)</addtitle><date>2016-04</date><risdate>2016</risdate><volume>68</volume><issue>4</issue><spage>562</spage><epage>569</epage><pages>562-569</pages><issn>2151-464X</issn><issn>2151-4658</issn><eissn>2151-4658</eissn><abstract>Objective
To assess the effect of a simple intervention on antinuclear antibody (ANA) test overuse by rheumatologists.
Methods
This was an explorative, pragmatic, before‐and‐after, controlled implementation study among rheumatologists working at 3 rheumatology departments in secondary and tertiary care centers in The Netherlands. The intervention was given in all study centers separately and combined education with feedback. Six outcome measures describe the intervention effects: the ANA/new patient ratio (APR), difference with the target APR, percentage of positive ANA tests, percentage of repeated ANA testing, percentage of ANA‐associated diseases, and APR variation between rheumatologists. Outcomes were compared between the pre‐ and postintervention period (both 12 months) using (multilevel) logistic regression or F testing. Results are reported together for centers 1 and 2, and separately for center 3, because ANA tests could not be linked to an individual rheumatologist in center 3.
Results
The APR decreased from 0.37 to 0.11 after the intervention in centers 1 and 2 (odds ratio [OR] 0.19, 95% confidence interval [95% CI] 0.17–0.22, P < 0.001) and from 0.45 to 0.30 in center 3 (OR 0.53, 95% CI 0.45–0.62, P < 0.001). The percentage of repeated ANA requests in all centers and the APR variation for centers 1 and 2 decreased significantly. Only in center 3 did the percentage of ANA‐associated diseases increase significantly.
Conclusion
A simple intervention resulted in a relevant and significant decrease in the numbers of ANA tests requested by rheumatologists, together with an improvement on 3 other outcome measures.</abstract><cop>United States</cop><pmid>26414008</pmid><doi>10.1002/acr.22725</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2151-464X |
| ispartof | Arthritis care & research (2010), 2016-04, Vol.68 (4), p.562-569 |
| issn | 2151-464X 2151-4658 2151-4658 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_510400 |
| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Adult Antibodies, Antinuclear - blood Biomarkers - blood Choice Behavior Female Humans Logistic Models Male Medical Overuse - prevention & control Medicin och hälsovetenskap Middle Aged Multivariate Analysis Netherlands Odds Ratio Practice Patterns, Physicians Predictive Value of Tests Rheumatology - methods Serologic Tests - utilization |
| title | Choosing Wisely in Daily Practice: An Intervention Study on Antinuclear Antibody Testing by Rheumatologists |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-04T22%3A50%3A06IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Choosing%20Wisely%20in%20Daily%20Practice:%20An%20Intervention%20Study%20on%20Antinuclear%20Antibody%20Testing%20by%20Rheumatologists&rft.jtitle=Arthritis%20care%20&%20research%20(2010)&rft.au=Lesuis,%20Nienke&rft.date=2016-04&rft.volume=68&rft.issue=4&rft.spage=562&rft.epage=569&rft.pages=562-569&rft.issn=2151-464X&rft.eissn=2151-4658&rft_id=info:doi/10.1002/acr.22725&rft_dat=%3Cproquest_swepu%3E1776094371%3C/proquest_swepu%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c4485-f42c08126563a809fd69c3dd3d49bb73d0b3064fc44b67a898517873856ef6bd3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1776094371&rft_id=info:pmid/26414008&rfr_iscdi=true |