Background/Purpose: The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) has a mission to deliver exceptional and equitable health care to children with rheumatic diseases with a current focus on patients with juvenile idiopathic arthritis (JIA). PR-COIN’s registry tracks outcome, process, data quality, and balancing measures. PR-COIN assesses and addresses disparities across demographic variables by creating network SMARTIE (specific, measurable, actionable, realistic, time-bound, inclusive, equitable) aims. One aim is to increase the percent of patients with oligoarticular and polyarticular JIA who have inactive or low disease activity by the 10-joint clinical Juvenile Arthritis Disease Activity Score (cJADAS10) from 81.6% to 85% in addition to decreasing the gap between patients with commercial insurance and Medicaid from 8.8% to 5% by December 31, 2025. An additional aim is to increase the percent of patients with JIA in no pain or with mild pain intensity from 80.6% to 83% while decreasing the disparity gap between Black and White patients from 9% to 5% during this same timeframe.

Methods: A key driver diagram was created highlighting the SMARTIE aims and identifying key drivers and change ideas (Figure 1). Data from quality measures between January 2023-February 2025 were stratified by insurance type (comparing patients with commercial insurance and Medicaid) or race (comparing White and Black patients) for 2 outcome measures – inactive or low disease activity by cJADAS10 and no or mild pain – and 2 process measures – receipt of self-management support (SMS) and completion of setting a treatment target of disease activity. The differences in subgroup medians portrayed on run charts were translated to run charts of disparity gaps.

Results: Patients with JIA on commercial insurance consistently have a higher rate of inactive or low disease activity compared to patients on Medicaid (Figure 2A). The disparity gap between these populations decreased from 10% to 9% in November 2023 (Figure 2B). The percent of White and Black patients with no or mild pain have both increased slightly since January 2023 (currently 82.8% and 73.8%, respectively), although the disparity gap of 8.8% has been stable throughout this period (Figure 3). White patients are more likely to receive SMS compared to Black patients with a disparity gap of 7.7%. Patients on Medicaid were more likely to have a treatment target set than patients with commercial insurance (33.4% and 27.7%, respectively).

Conclusion: PR-COIN is striving to provide equitable health care to patients with JIA by making health equity a strategic priority, setting network aims with a health equity focus, and by assessing for differences in health outcomes related to social or demographic factors. We found a disparity by insurance type in our inactive or low disease activity measure. Disparities by race were present in pain intensity score and receipt of SMS. A focus on treatment target setting with patients on Medicaid may mitigate disparities in outcomes. PR-COIN will continue to monitor and address these disparity gaps over time to improve care for all patients with JIA. Further research into persistence of disparities is warranted.

Figure 1. PR-COIN’s key driver diagram.

Figure 2. Run charts demonstrating inactive or low disease activity by insurance status (A) and the gap in performance by insurance status (B).

Figure 3. Run charts demonstrating no or mild pain by race (A) and the gap in performance by race (B).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-disparities-in-outcomes-and-processes-of-care-for-patients-with-juvenile-idiopathic-arthritis-in-the-pediatric-rheumatology-care-and-outcomes-improvement-network/