Evidence map›Paper›PMID 26862352›Full record

ArticleThe open rheumatology journal2015

Applying Choosing Wisely: Antinuclear Antibody (ANA) and Sub-Serology Testing in a Safety Net Hospital System.

Lisa Anne Davis, Barbara Goldstein, Vivian Tran, Angela Keniston, Jinoos Yazdany, Joel Hirsh, Amy Storfa, JoAnn Zell

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The open rheumatology journal, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.2field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Lisa Anne DavisDenver Health and Hospital Authority, Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA.
Barbara GoldsteinDenver Health and Hospital Authority, Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA; National Jewish Health, Denver, CO, USA.
Vivian TranDenver Health and Hospital Authority, Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA.
Angela KenistonDenver Health and Hospital Authority, Denver, CO, USA.
Jinoos YazdanyUniversity of California San Francisco, San Francisco, CA, USA.
Joel HirshDenver Health and Hospital Authority, Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA.
Amy StorfaDenver Health and Hospital Authority, Denver, CO, USA.
JoAnn ZellDenver Health and Hospital Authority, Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA; National Jewish Health, Denver, CO, USA.
Health and Hospital Corporation · USUniversity of Colorado Denver · USNational Jewish Health · USUniversity of California, San Francisco · US

Funding

The Interplay of Sociodemographic and Genetic Factors in SLE Health DisparitiesP60AR053308 · NIAMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI CRISWELL, LINDSEY ANN · 2006 to 2016
$11.8M
Evaluating Health Care Quality in Systemic Lupus ErythematosusK23AR060259 · NIAMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI YAZDANY, JINOOS · 2011 to 2015
$638k
NIAMS NIH HHS K23 AR060259NIAMS NIH HHS P60 AR053308
6 · The paper itself

Abstract

objectiveIn 2013, the American College of Rheumatology (ACR) participated in the Choosing Wisely campaign and devised a recommendation to avoid testing antinuclear antibody (ANA) subserologies without a positive ANA and clinical suspicion of disease. The goals of our study were to describe ANA and subserology ordering practices and predictors of ordering concurrent ANA and subserologies in a safety-net hospital.

methodsWe identified ANA and subserologies (dsDNA, Sm, RNP, SSA, SSB, Scl-70 and centromere) completed at Denver Health between 1/1/2005 and 12/31/2011. Variables included demographics, primary insurance, service, and setting from which the test was ordered. We performed multivariable logistic regression to determine predictors of concurrent ordering of ANA and subserologies.

resultsDuring seven years, 3221 ANA were performed in 2771 individuals and 211 (6.6%) were performed concurrently with at least one subserology. The most common concurrent subserologies were dsDNA (21.8%), SSA (20.8%), and SSB (19.7%). In the multivariable logistic analysis, significant predictors of concurrent ANA and subserologies were the labs being ordered from subspecialty care (OR 8.12, 95% CI 5.27-12.50, p-value <0.0001) or from urgent/inpatient care (OR 3.86, 95% CI 1.78-8.38, p-value 0.001). A significant predictor of decreased odds was male gender (OR 0.32, 95% CI 0.21-0.49, p-value <0.0001). Five individuals (2.2% of the negative ANA with subserologies ordered) had a negative ANA but positive subserologies.

conclusionOf 3221 ANA, 6.6% were performed concurrently with subserologies, and subspecialists were more likely to order concurrent tests. A negative ANA predicted negative subserologies with rare exceptions, which validates the ACR's recommendations.

Indexed as

Antinuclear antibody (ANA)choosing wiselyordering practicesquality indicatorsquality of careresource management.

Identifiers

PMID26862352
PMCPMC4740967
OpenAlexW2172835132

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.