Background/Purpose: Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) is a multi-site learning network designed to improve outcomes of juvenile idiopathic arthritis (JIA) care.  Teams collect point of care data on measures of process of care and outcomes of care for the purposes of analysis to guide improvement activities.  Eleven North American pediatric rheumatology centers participate.  This report illustrates our improvement in several JIA process quality measures (QMs).

Methods: Process of care QMs targeted for improvement include measurement of:  arthritis-related pain, physician global assessment, joint count, health-related quality of life, physical function, as well as screening for uveitis, medication toxicity, and tuberculosis per guidelines.  Outcome measures for JIA include clinical inactive disease, no or mild pain level, and optimal physical functioning.  Network goals were determined for each process and outcome measure. Data are collected with IRB approval and informed consent, and the shared registry for data entry is the ACR’s Rheumatology Clinical Registry. Site-specific and aggregate data are analyzed and displayed monthly via statistical process control charts allowing PR-COIN to track performance over time.  Individual centers use established quality improvement methodology to reach and exceed pre-determined goals.

Results: Data from 3231 encounters for 905 JIA patients have been collected since April 2011.  QMs with performance meeting or exceeding initial goals include:  documentation of complete joint count every 180 days, measurement of arthritis-related pain at every visit, functional assessment every 180 days, and documentation of baseline toxicity labs.  For PR-COIN network as a collective unit, QMs improved in five processes– measurement of functional ability, completion of ongoing medication toxicity labs, documentation of complete joint count, documentation of annual behavioral counseling, and measurement of health-related quality of life.  All of these measures had a sustained shift above the baseline mean, demonstrating special cause.  In addition, five sites have demonstrated individual improvement in at least one process QM.

Conclusion: PR-COIN sites are collectively and individually demonstrating significant improvements in JIA process of care QMs.  Quality improvement efforts in PR-COIN are ongoing with the goal of improving the outcome for patients with JIA.