Background/Purpose: Chronic uveitis is one of the more severe morbidities associated with juvenile idiopathic arthritis (JIA). Risk of developing uveitis, and the frequency of uveitis screening visits, differs between the different JIA subtypes. Through participation in the Pediatric Rheumatology Care & Outcomes Improvement Network (PR-COIN), a quality improvement collaborative, we developed a uveitis screening tool for patients to bring to their ophthalmologist to improve communication between providers. This tool includes education for the family on uveitis. Our objective was to determine if use of this tool improved adherence to uveitis screening recommendations and documentation of uveitis screening.

Methods: A retrospective chart review was conducted of 243 JIA patients without uveitis identified from our Childhood Arthritis & Rheumatology Research Alliance Registry and PR-COIN databases in the 13 months before and after beginning our participation in PR-COIN. Collected data included demographics, documentation of the uveitis assessment, and documentation of patient education.  Effectiveness of implementation of the screening tool was assessed by comparing compliance with uveitis screening in the two time periods. Continuous variables were summarized as median (interquartile range). Categorical variables were summarized as frequency (percent).  Paired binary outcomes of screening compliance were examined using McNemar’s test.

Results: Data from 184 patients were included (table 1). Patients were excluded if they did not follow up during the study period or if charts were unavailable for review.   Prior to our participation in PR-COIN, 132 (71.7%) patients reported compliance with screening but only 50 (27%) patients had documentation of their uveitis screening visits.  Following introduction of our uveitis screening tool, documentation of screening increased significantly to 45.7% (table2).  Of the 184 patients, 52 (28%) were non-compliant by self-report prior to participation in PR-COIN. Of those 52 patients, 32 (61.5%) increased their compliance following implementation of our uveitis screening tool.

Conclusion: Since joining PR-COIN and implementing a uveitis education and communication tool, there was improvement in patient compliance with uveitis screening.  There was significant improvement in documentation by ophthalmology of the patient’s visit.  Simple tools such as a uveitis screening form can facilitate communication with the ophthalmologist and better educate JIA patients on the importance of uveitis screening, thus improving their care.