Background/Purpose: Wait time to pediatric rheumatology care for patients with Juvenile Idiopathic Arthritis (JIA) is a nationally endorsed quality measure in Canada. Target wait times for systemic JIA are 7 days from referral to pediatric rheumatology care, and 4 weeks for other JIA categories. The purpose of this study was to measure this quality indicator and evaluate factors associated with JIA wait times at a single academic pediatric rheumatology center.

Methods: This was a retrospective cohort study of patients with a diagnosis of JIA participating in a pharmacogenetics study who had demographic and disease-related data collected prospectively between 2002-2018. The time between referral date and first pediatric rheumatology visit was extracted from clinic charts and clinical variables from a pharmacogenetics study database. Factors evaluated included JIA category, age, sex, distance from the clinic, baseline number of active joints, pain and C-reactive protein (CRP) at the first clinic visit. Distance from clinic was calculated by geocoding the latitude and longitude of the patient’s postal code using the Postal Code Conversion File, with distance calculations made using ArcGIS by calculating the shortest distance to the clinic using roadways. Urban versus rural classification of patient residence was according to Statistics Canada definitions. Descriptive characteristics and wait time measures are reported using medians (interquartile range, IQR) given the non-normal distributions. Non-parametric Kruskal-Wallis rank test was used to examine whether there was any difference in wait times among patients with different categories of JIA. Cox proportional hazard modelling was used to evaluate potential factors associated with wait time.

Results: 164 patients with JIA were eligible for inclusion, of which 116 were female (71%). The median age at diagnosis was 8.0 (IQR 3.5, 12.0) years. The majority of patients had oligoarticular JIA (n=75, 46%) or rheumatoid factor-negative polyarticular JIA (n=48, 29%) and 6 patients had systemic JIA (4%). The majority of patients (n=102, 62%) were from Calgary. The median network distance for patients between their residence and the clinic was 22.8 kilometers (IQR 13.5, 127.8). There was a median of 22 days between referral and pediatric rheumatologist visit (IQR 9, 45), and there was no significant difference between the wait times among JIA categories (p=0.055). Overall, 62% of JIA cases met the established wait time benchmarks. Using Cox-proportional hazard modeling, higher age was associated with longer wait times (HR 0.94, 95% CI 0.89, 0.98, p=0.005).

Conclusion: The median wait time from referral to pediatric rheumatologist visit for patients with JIA in this study met the national benchmark, although some patients experienced long wait times for appointments. Wait times did not significantly differ by JIA category but older patients waited longer. This work highlights the importance of monitoring of wait times as a quality indicator.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-we-meeting-benchmarks-for-wait-times-to-pediatric-rheumatology-care-for-juvenile-idiopathic-arthritis-jia/