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The aim of this study is to assess the effect of a simple intervention (a combination of education and feedback) on Antinuclear Antibody (ANA) testing.
This aim was chosen because of the known overuse of many laboratory tests, of which ANA testing is one. As overuse of ANA tests can have negative consequences (both for patients and society), the investigators designed an intervention to see how this would influence Antinuclear Antibody testing by rheumatologists.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Education and feedback | Experimental | The intervention consisted of a one-hour, small group educational session. During this session information on rational ANA testing was provided and feedback on current ANA testing was provided to the rheumatologists. A booster session with the same components was held 6 months after the first session. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Education and feedback | Behavioral |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change from baseline (pre-intervention) ANA/new patient ratio (APR) at 12 months (post-intervention) | Number of ANA tests divided by the number of new patients | Pre- and post-intervention (both 12 months) |
| Change from baseline (pre-intervention) % of positive ANA tests at 12 months (post-intervention) | Percentage of ANA tests reported as positive by the local laboratory. ANA tests reported as 'weakly positive' are regarded as negative. | Pre- and post-intervention (both 12 months) |
| Change from baseline (pre-intervention) % of repeated ANA testing at 12 months (post-intervention) | Percentage of patients with ≥1 ANA test in 12 months (pre- or post-intervention period) | Pre- and post-intervention (both 12 months) |
| Change from baseline (pre-intervention) % of ANA associated diagnoses at 12 months (post-intervention) | Percentage of patients, in which an ANA is done during the study period, with final diagnosis of SLE, SSc, PM/DM, MCTD or SS | Pre- and post-intervention (both 12 months) |
| Change from baseline (pre-intervention) APR variation between rheumatologists at 12 months (post-intervention) | Standard deviation around the mean APR, calculated from the APRs of the individual rheumatologists | Pre- and post-intervention (both 12 months) |
| Change from baseline (pre-intervention) reaching the of target APR at 12 months (post-intervention) | Difference (percentage) between the actual APR and the target-APR defined during the intervention |
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Inclusion Criteria rheumatologists:
Exclusion Criteria rheumatologists:
Inclusion Criteria patients - all patients with an ANA test requested by an included rheumatologist during the study period
Exclusion Criteria patients
- patients with an ANA test requested during a clinical admission
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| Name | Affiliation | Role |
|---|---|---|
| Ronald van Vollenhoven, MD, PhD | Karolinska Institutet | Principal Investigator |
| Marlies Hulscher, PhD | Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands | Principal Investigator |
| Alfons den Broeder, MD, PhD | Sint Maartenskliniek, Nijmegen, the Netherlands | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sint Maartenskliniek | Nijmegen | Gelderland | 6500 GM | Netherlands | ||
| Radboud University Medical Center |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26414008 | Derived | Lesuis N, Hulscher ME, Piek E, Demirel H, van der Laan-Baalbergen N, Meek I, van Vollenhoven RF, den Broeder AA. Choosing Wisely in Daily Practice: An Intervention Study on Antinuclear Antibody Testing by Rheumatologists. Arthritis Care Res (Hoboken). 2016 Apr;68(4):562-9. doi: 10.1002/acr.22725. |
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| ID | Term |
|---|---|
| D012216 | Rheumatic Diseases |
| ID | Term |
|---|---|
| D009140 | Musculoskeletal Diseases |
| D003240 | Connective Tissue Diseases |
| D017437 | Skin and Connective Tissue Diseases |
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| ID | Term |
|---|---|
| D004522 | Educational Status |
| ID | Term |
|---|---|
| D012959 | Socioeconomic Factors |
| D011154 | Population Characteristics |
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| Pre- and post-intervention (both 12 months) |
| Nijmegen |
| Netherlands |
| Maartenskliniek Woerden | Woerden | Netherlands |