Background/Purpose: The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) is a quality improvement (QI) multi-center “learning network” that performs QI and research while tracking progress through data collection, analysis, and display.  The mission is to optimize processes of care and improve outcomes in juvenile idiopathic arthritis (JIA). PR-COIN began operating in the spring of 2011 and currently has 12 participating sites in the United States and Canada. This is the first report of our data.

Methods: Our approach is based on the Institute for Healthcare Improvement Breakthrough Series Collaborative Model with planned interventions to improve outcomes based on the Chronic Illness Care Model. Conference calls, web-based information exchange, and face-to-face learning sessions are forums for teams to gain expertise in QI science, share knowledge, and develop new strategies to improve care. Teams conduct “Plan-Do-Study-Act” cycles to enact improvement and submit data and progress reports monthly. After informed consent/assent is obtained, site patient data are entered into the ACR’s Rheumatology Clinical Registry in order to track progress of the network over time. Design of data collection forms allows assessment of performance on published proposed JIA quality measures (QM) (Arthritis Care Res 2011 Jan;63(1):10-6) and monitoring of clinical outcomes. 13 processes of care QMs and 4 clinical outcomes QMs are tracked.  Site specific and aggregate data are analyzed monthly and provided with transparency as feedback to the sites.  Benchmarking is possible through analysis of the data submitted by participating practices, and shared information can accelerate improvement throughout the network.

Results: As of May 2012, 516 patients from 7 sites have been entered into the registry for longitudinal assessment.  Performance exceeded goal on 2 process of care QM: measurement at clinic visits of complete joint count (mean 100%, goal 90%) and pain assessment (mean 96%, goal 90).  Examples of process QM requiring improvement work include: uveitis screening per Heiligenhaus guidelines (mean 72%, goal 90%); toxicity labs for DMARDs per guidelines (mean 72%, goal 90%); measurement every 180 days of: functional ability (mean 81%, goal 90%) , and HRQOL  (mean 3%, goal 90%). Our baseline outcome measures showed: 77% of patients have a pain score < 3; 58% patients have an optimal CHAQ score of 0; and 33% of patients on JIA medication and 60% patients off JIA medication could be defined as having clinical inactive disease.

Conclusion: PR-COIN is a growing international QI learning network. Our baseline data demonstrate mixed performance on measures of processes of care. As we reach target performance goals for our measures over time, we will continue to raise the bar for performance. The next phase of our project is to use interventions including implementation of an already developed population management tool, creation of a pre-visit planning tool to facilitate measurable improvement in meeting benchmarks for process of care, and orchestrated testing of which QI interventions most positively impact clinical outcomes.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-delivery-of-care-for-jia-across-a-multi-center-network-using-a-shared-data-registry-and-quality-improvement-science-the-pediatric-rheumatology-care-and-outcomes-improvement-network/