Background: Despite the gluten-free diet (GFD) being the primary treatment for celiac disease (CeD), 44% of children struggle with adherence. By improving patient access to care through stakeholder-informed interventions, GFD adherence may also improve.
Setting/Population: Participants will include all pediatric patients seen at a multidisciplinary celiac tertiary care center between August 2023 and October 2026. Data collection is ongoing. The center’s team of providers includes gastroenterologists, an advanced practice practitioner, a registered dietitian, and a psychologist.
Methods: This quality improvement (QI) project was conducted in two phases. Phase one consisted of implementing the Define-Measure-Analyze-Improve-Control (DMAIC) process to elicit patient and provider feedback, identify barriers, and develop interventions to address underutilization of services (August 2023 – August 2024). In phase two, interventions are being implemented, and patient feedback surveys and adherence assessment outcomes are being obtained (August 2024 – October 2026).
Results: As identified by Pareto and fishbone charts, the primary barrier to service utilization was communication between providers and patients. In the initial survey, 80–90% of patients knew about the available services, and 65–80% reported accessing them. Providers used standardized provider-to-patient electronic health record communication 60%-81% of the time. This intervention had no impact on service utilization from August 2024 to June 2026. Patient feedback surveys following each clinical touchpoint, patients’ lab results, results of the dietitian adherence review, and service utilization data post-QI scheduling intervention are currently being collected, and their correlation to QI interventions and service engagement will be analyzed and reported.
Conclusions: GFD adherence in CeD is alarming, with underutilization of services in this sample primarily linked to patient communication barriers. Most providers used standardized provider-to-patient communication; however, it has not affected patients’ use of resources. Data are being collected and will be analyzed to assess the impact of service utilization on GFD adherence.