Background/Purpose:  Disease outcomes can depend, to a large extent, on one’s ability to manage their condition effectively. For children with JIA this means managing oral, injectable, or intravenous medications, managing multiple appointments, regular blood work, imaging studies, and performing home exercise programs. These activities must be integrated into daily life with consideration for developmental, intellectual, and psychosocial well-being of the child and family. Provision of Self-Management Support (SMS) is one of 6 essential elements of care identified in The Chronic Care Model. Practice teams must develop systematic processes designed to address self-management and foster patient’s confidence and self-management skills. However, providers are not routinely trained in providing SMS. The purpose of this study was to develop systematic processes by which practice teams within Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) develop skills, tools, and mechanisms to effectively implement SMS.

Methods:  Three key components utilized to prepare for successful implementation of SMS by teams included: 1) provider and health care team training in Behavior Change Counseling (BCC), 2) tool development for self-management assessment, barrier assessment, and an action plan worksheet, 3) use of quality improvement (QI) methods to identify successful implementation processes, and to support their application within PR-COIN practice teams. A co-production model, including researchers, health providers and parents was used for tool development and process integration.

Results:  Nine centers participated in two 4 hour training sessions on BCC and elements of SMS delivered via interactive webinar technology. A self-management assessment tool (assessing visit goals, self-efficacy, health distress, and adherence), barriers assessment, intervention tools, and action plan were tested across 9 centers and refined. Data tracking of performance for tool implementation and barriers to treatment were collected. 84% or participants completed BCC training. Aggregate data for tool integration into clinic flow was 85%. Of multiple barriers assessed, concern for long term side effects was highest for all medication modalities. Specific barriers to adherence of medications were forgetting to take medication and pain associated with injections. Monthly webinars were conducted to debrief on progress, learnings and share best-practices on SMS implementation. Feedback from teams and parents indicated SMS tools used in clinical encounters were helpful to address barriers/concerns of patients, to decrease provider assumptions and increase patient activation.

Conclusion:  This project implemented a novel approach to SMS training with interactive webinar instruction showing feasibility of this technology to facilitate future spread of SMS skills training to other centers. The co-production model with caregivers collaborating with teams facilitated the tool development and relevance to target audience. Specific QI methods building on skills learned from participation in PR-COIN allowed more efficient uptake of SMS into clinic practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/leveraging-a-learning-network-to-implement-and-standardize-self-management-support-into-care-delivery-experience-of-pediatric-rheumatology-care-and-outcomes-improvement-network/