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Abstract Number: 2963

Improving Clinically Inactive Disease in Patients with Juvenile Idiopathic Arthritis- a Quaternary Center Experience

Cagri Yildirim-Toruner1, Ohoud AlAhmed2, Fatima Barbar-Smiley3, Karla Jones3, Melanie Kohlheim4, Stephanie Lemle5, Darby MacDonald2, Evan Mulvihill6, Edward Oberle2, Aliese Sarkissian2, Vidya Sivaraman7, Bethanne Thomas2, Kelly Wise8 and Stacy P. Ardoin1, 1Division of Rheumatology, Nationwide Children’s Hospital, Columbus, OH, 2Pediatric Rheumatology, Nationwide Children's Hospital, Columbus, OH, 3Rheumatology, Nationwide Children's Hospital, Columbus, OH, 4Pediatric Rheumatology Care and Outcomes Improvement Network, Cincinnati, OH, 5Nationwide Children's Hospital, Columbus, OH, 6Pediatrics and Rheumatology, Nationwide Children's Hospital, Columbus, OH, 7Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, 8Specialty Pharmacy/Rheumatology, Nationwide Children's Hospital, Columbus, OH

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Assessment, Disease Activity, juvenile idiopathic arthritis (JIA), outcomes and quality improvement

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Session Information

Date: Wednesday, October 24, 2018

Session Title: 6W019 ACR Abstract: Measures of Healthcare Quality II: QI in SLE, Gout & JIA (2958–2963)

Session Type: ACR Concurrent Abstract Session

Session Time: 11:00AM-12:30PM

Background/Purpose: Juvenile idiopathic arthritis (JIA), the most common pediatric rheumatologic diagnosis, influences many aspects of a child’s life. Although there is no known cure, disease control is often achievable. Early recognition and treatment leads to better disease control that is crucial to prevent chronic pain, irreversible joint damage, and future disability. Clinical Inactive Disease (CID) has been defined and is the accepted outcome measure. In our large pediatric quaternary referral hospital, the number of JIA patients achieving CID was 11% whereas it is reported up to 40% in other centers nationally.  Here, we report improvement from 11% to 37% CID within two years by implementing a quality improvement project.

Methods: A key driver diagram (KDD) was used to identify barriers to achieving CID and to develop optimal disease management strategies. The most effective interventions were initially centered around educating parents and patients on disease management, pre-visit planning and provider data entry of disease activity criteria. The physician global assessment (PGA), a subjective score with interprovider variability, was identified as one of the top barriers to inactive disease. In efforts to standardization, PGA scoring exercises were conducted. In addition, providers reviewed currently active patient cases in population management to provide inputs to optimize therapy. These exercises helped standardize disease activity level scoring by allowing providers to challenge each other regarding optimal care of patients. Transparency in provider level feedback surrounding PGA scores and the percentage of patients with inactive disease was shared quarterly with providers. We had multiple other interventions as summarized in KDD (Figure 1).

Results: During the baseline period (Jan 2015-May 2016), only 11% of patients at our center met criteria for CID. After initial interventions, 20% of patients were considered inactive as of June 2016 (p-value <0.001). As population management and PGA exercises took effect, another shift in data occurred in January 2017, resulting in 25% of patients having no disease activity (p-value<0.001).  The team has five data point reaching goal, ready for another shift in data (Figure2).

Conclusion: A dedicated QI project, focusing on multiple interventions, improved the disease activity level of patients with JIA. It is expected that as the team continues with these exercises and proceeds with next steps, the percentage of patients with inactive disease will continue to rise.


Disclosure: C. Yildirim-Toruner, None; O. AlAhmed, None; F. Barbar-Smiley, None; K. Jones, None; M. Kohlheim, None; S. Lemle, None; D. MacDonald, None; E. Mulvihill, None; E. Oberle, None; A. Sarkissian, None; V. Sivaraman, None; B. Thomas, None; K. Wise, None; S. P. Ardoin, None.

To cite this abstract in AMA style:

Yildirim-Toruner C, AlAhmed O, Barbar-Smiley F, Jones K, Kohlheim M, Lemle S, MacDonald D, Mulvihill E, Oberle E, Sarkissian A, Sivaraman V, Thomas B, Wise K, Ardoin SP. Improving Clinically Inactive Disease in Patients with Juvenile Idiopathic Arthritis- a Quaternary Center Experience [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/improving-clinically-inactive-disease-in-patients-with-juvenile-idiopathic-arthritis-a-quaternary-center-experience/. Accessed January 28, 2023.
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