Background: Celiac Disease (CD) affects at least 3 million American and is now recognized as one of the most common lifelong disorders in Europe and the United States, with fourfold increased prevalence since 1950 in the U.S. 1 in 100 adults, and 1 in 80 children have celiac disease. CD is an immune-mediated genetic disease that causes small intestine enteropathy, which prevents nutition absorption. Classic characteristics of CD include diarrhea, abdominal pain and bloating. Primary care providers nationwide are unfamiliar with atypical CD because the signs and symptoms are often vague, and CD is not thought of as a potential diagnosis until a patient has suffered more severe complications. Undiagnosed celiac disease is a major cause of non-Hodgkin’s lymphoma. Most primary care providers recognize typical signs and symptoms of CD, but often were not as familiar with atypical or latent CD. CD has diverse presentations, ranging from malabsorption to fatigue to depression. EBP Framework: The Consolidated Framework for Implementation Research (CFIR) theory and the Johns Hopkins Nursing Evidence Based Practice (JHNEBP) model were selected to guide implementation of the “What is You Celiac Score” assessment tool into primary practice. The project is to implement this assessment tool to answer the clinical question, “will providers, using the “What is you Celiac Score” questionnaire, compared to no questionnaire, identify more patients with possible CD, to refer for testing, over a four-week period.” Methods: Retrospective chart reivew pre-intervention established that providers refer patients for CD testing based on signs and symptoms typically associated with classic CD. Providers were then educated on signs and symptoms of latent and atypical CD and a CD assessment tool was implemented to identify patients for testing. Providers were asked to use the tool when assessing patients, and at the end of the 4-week implementation period, data was collected and analyzed for efficacy of the screening tool, compared to clinical expertise alone, in identifying more patients, consistently and earlier. Findings/Results: Pre-intervention, nine patients out of approximately 7000 were assessed for CD, five were diagnosed with CD. Eighty-percent of those diagnosed with CD has a cancer diagnosis first. Post-intervention, sixteen out of approximately 600 patients were assessed for CD, seven were diagnosed and none had a cancer diagnosis before CD. Conclusion/Recommendations: Signs and symptoms of CD can often overlap with other conditions and it is vital that primary care providers and other providers learn about the multiple ways in which CD can present and have a heightened suspicion among patient populations. A CD tool helped providers streamline assessment and referral for CD testing.
