Background/Purpose: Prior to 2024, our institution did not have a clinical pathway for management of Kawasaki disease (KD). In April 2024, a multidisciplinary team of pediatric hospitalists, rheumatologists, and cardiologists convened to develop an institutional pathway to improve outcomes for KD patients. Since pediatric rheumatology oversees intensification therapies at our institution, our specific goal was to increase the proportion of high-risk KD patients receiving primary intensification treatment from 25% to 75%. Timely primary intensification improves patient outcomes by reducing the risk of coronary artery aneurysms and shortening illness duration, while also decreasing healthcare utilization by lowering the need for a second dose of IVIG and reducing length of stay.

Methods: We conducted a retrospective review of KD cases diagnosed between May 2020 and May 2024 to establish baseline practices for identifying high-risk patients and utilization of intensification therapies. Key drivers for under-utilization of primary intensification were identified and addressed through targeted interventions, which included creating an institutional KD pathway that was launched June 2025, as well as internal treatment guidelines for pediatric rheumatology providers. Prospective chart review was conducted for all KD patients during the first three months post-implementation.

Results: Within three months of implementation, the proportion of high-risk KD patients receiving primary intensification therapy increased from 25% to 85%. Improvements were driven by increased identification of high-risk KD patients, increased rheumatology consultation, and increased utilization of intensification therapies. Additionally, the need for repeat IVIG administration decreased following pathway implementation.

Conclusion: Embedding standardized risk identification into an institutional KD pathway and developing intensification treatment guidelines increased primary intensification rates among high-risk KD patients. This QI initiative demonstrates how multidisciplinary efforts can effectively translate research evidence into clinical practice. Ongoing data collection will assess sustainability with six-month outcomes, which will be available at the time of the PRYSM symposium.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/bridging-evidence-and-practice-new-institutional-pathway-increases-primary-intensification-rates-for-children-with-high-risk-kawasaki-disease/