Evaluation of Turner Syndrome International Consensus Guideline Compliance in Multiple Subspecialty Clinics Verses a Coordinated Multidisciplinary Clinic Format

Turner syndrome’s (TS) lifelong association with multi-organ system comorbidities necessitates the effective implementation of, and adherence to, screening guidelines. Our team evaluated the effectiveness in implementing the 2016 Cincinnati International Turner Syndrome consensus guidelines [1] in a single, coordinated, multidisciplinary clinic (MDC) day format compared to multiple separate subspecialty clinic visits. A retrospective analysis of patients with TS followed at our pediatric tertiary referral center between December 2016 and April 2020 was conducted. Exclusion criteria included patients that were not seen in our pediatric endocrine clinic for over 24 months, age over 22 years, and those without confirmed genetic diagnosis of TS. The population was separated into two groups; girls who attended at least 1 MDC day each year and girls who had at least 1 endocrinology clinic visit in the last 14 months, but who were not part of the MDC (non-MDC). Age appropriate screenings included TSH, hepatic function test, Vitamin D level, blood glucose and/or HgA1C, celiac screening panel, hearing/auditory screening, eye examination, electrocardiogram, and echocardiogram. A total of 112 girls met study criteria. Sixty-eight were managed in the MDC and 44 managed in non-MDC. Only 36.6% of all the girls met all the above age-appropriate screening recommendations, 75.6% of which were managed in MDC (p-value 0.014). MDC girls had higher screening compliance rates vs non-MDC girls for TSH (95% vs 76%, p-value 0.017), auditory evaluation (85% vs 50%, p-value <0.001), HgA1c and/or serum blood glucose levels (97% vs 76%, p-value 0.017), and tissue transglutaminase levels (95% vs 83%, p-value 0.048). No statistically significant difference was found with overall screening guideline compliance and insurance status, race/ethnicity, or age at time of the patients last recorded clinic visit. In conclusion, the MDC day format showed superior screening guideline compliance, both overall and to multiple specific screening tests, compared to those seen in multiple uncoordinated, single-disciplinary individual provider clinics. Overall guideline adherence remained low (36.6%), highlighting the need for continued optimization and improvement in guideline compliance. Reference: [1] Gravholt, C.H., et al., Eur J Endocrinol, 2017. 177(3): p. G1-G70.