Increasing Rates of Remission in Juvenile Idiopathic Arthritis through a Quality Improvement Learning Network – the Pediatric Rheumatology Care and Outcomes Improvement Network

Esi M. Morgan DeWitt¹, Stacy P. Ardoin², C. April Bingham³, Beth S. Gottlieb⁴, Ronald Laxer⁵, Nancy Griffin⁶, Jesse Pratt⁷, Anne Paul⁸, Daniel Lovell⁹, Judyann C. Olson¹⁰, Murray H. Passo¹¹, Jennifer E. Weiss¹², Tzielan C. Lee¹³, Sheetal S. Vora¹⁴, Melissa M. Hazen¹⁵ and Peter Margolis¹⁶, ¹Department of Pediatrics, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, ²Pediatric & Adult Rheumatology, Ohio State University College of Medicine, Columbus, OH, ³Penn State Hershey Children's Hospital, Hershey, PA, ⁴Pediatric Rheumatology, Cohen Children's Medical Center of New York, New Hyde Park, NY, ⁵Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada, ⁶James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, ⁷Cincinnati Children's Hospital Medical Center, Cincinnati, OH, ⁸Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, ⁹Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, ¹⁰Medical College of Wisconsin, Milwaukee, WI, ¹¹Pediatric Rheumatology, Medical University of South Carolina, Charleston, SC, ¹²Pediatric Rheumatology, Joseph M Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ, ¹³Pediatric Rheumatology, Stanford University School of Medicine, Stanford, CA, ¹⁴University of North Carolina Chapel Hill, Chapel Hill, NC, ¹⁵Division of Immunology, Boston Children's Hospital, Boston, MA, ¹⁶Clinical Effectiveness, Cincinnati Children's Hospital, Cincinnati, OH

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Chronic disease care, patient outcomes, Pediatric rheumatology, quality improvement and quality of care

Session Information

Title: Quality Measures and Quality of Care

Session Type: Abstract Submissions (ACR)

Background/Purpose

The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) since 2011 has used quality improvement (QI) methods, chronic illness care model interventions, and a modified, sustainable, Breakthrough Series Collaborative approach to operations. As the network matures in use of population management and pre-visit planning interventions measureable improvements in remission outcomes for children with juvenile idiopathic arthritis (JIA) are being realized.

Methods

Teams conduct Plan-Do-Study-Act cycles using the Model for Improvement. Sites contribute data to a shared registry. Informed consent is obtained from patients for research uses. Data is displayed in run charts, funnel charts, and Pareto charts. Strategies for use of the Population Management Tool include peer review of patients with more than mild disease activity assessed by Physician Global Assessment >3 with decision support treatment algorithms. Pre-visit planning increases reliability of completion of process measures of care (medication safety lab tests, uveitis eye screening) and flags patients for needed services such as PT, OT, or if there is inadequate disease control. Patients are being engaged at network and local levels to inform priorities and contribute to improvement work. Teams share resources, materials and best practices on monthly webinars, “Learning Labs”, and semi-annual face-to-face “learning sessions”.

Results

8 of 11 participant sites submit data to the registry (ACR Rheumatology Clinical Registry). 1,457 patients contribute 7,040 encounters. Rates of clinical remission on medication for 6 months were statistically increased from baseline of 37.2% to 48.4% in the aggregate. There is variability in current site performance by >20%, with remission rates for May 2014 ranging from 39.4% – 62.7% at individual sites.

Conclusion

PR-COIN has marked a turning point from early improvement in process measures of care to demonstrable improvement in outcomes as teams are more experienced in QI methods and more reliably implementing pre-visit planning and using population management approaches. Variability in site performance provides opportunity for shared best practices. Challenges to growth have included delays in regulatory approval, and currently a single IRB model is being implemented. Double data entry is a barrier to efficient participation and teams are jointly developing “SmartForms” for electronic health records to facilitate standardized data collection and electronic data transfer. Patient engagement is a new direction expected to support enrollment and influence self-management initiatives.

Disclosure:

E. M. Morgan DeWitt,
None;

S. P. Ardoin,
None;

C. A. Bingham,
None;

B. S. Gottlieb,
None;

R. Laxer,
None;

N. Griffin,
None;

J. Pratt,
None;

A. Paul,
None;

D. Lovell,
None;

J. C. Olson,
None;

M. H. Passo,
None;

J. E. Weiss,
None;

T. C. Lee,
None;

S. S. Vora,
None;

M. M. Hazen,
None;

P. Margolis,
None.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increasing-rates-of-remission-in-juvenile-idiopathic-arthritis-through-a-quality-improvement-learning-network-the-pediatric-rheumatology-care-and-outcomes-improvement-network/