Background/Purpose: The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) is a multi-site learning health network organized to improve outcomes of juvenile idiopathic arthritis (JIA). PR-COIN has a centralized registry that tracks 10 outcome measures, 6 process measures, 3 data quality measures, and 1 balancing measure. A ‘gap to target’ feature was implemented in the registry for each categorical quality measure (QM). This feature enumerates the count of individual patients (or visits) that would need to meet qualification to pass the QM in order for the performance to reach the established network QM target value. Reporting the performance deficit in individual terms sharpens improvement focus, conveys the order of magnitude to reach the goal, and facilitates interventions to close quality of care gaps for individual patients at the site level.

Methods: The PR-COIN registry captures data from 21 sites with more than 14,500 JIA patients and 96,000 visits since 2011. In 2022, our collaborative switched to a new registry vendor, Hive Solutions, LLC., and developed a new measure dashboard and population management tool. Network performance goals were updated in 2024 based on current network-wide performance, balanced with performance data of specific sites selected based on data completeness for each given measure and representativeness (over 75% of clinic patients enrolled in registry), input of parent/patient partners, and published JIA outcomes. Additional registry functionality was added to include a ‘gap to target’ feature both at a network and site level.

Results: The ‘gap to target’ was added to our main measure dashboard page (Figure 1). When viewing network data, the ‘gap to target’ column identifies the specific number of patients (or visits) needed to be added to a measure numerator (based off the previous month’s data) for the network goal to be achieved. Specific sites can also review this data in relation to their own JIA population and the network targets with a separate feature to identify specific patients not yet meeting the measure definition. An additional ‘gap to target’ page can look at each QM by month (starting in May 2024) to identify the gap to network target by percentage with a quick visual to denote whether that month’s performance was better than the target (green check) or lower than the target (orange box), if the desired direction of improvement is up (Figure 2).

Conclusion: Identifying specific gaps to target for QMs will help quantify the scope of effort needed to achieve network goals. This gap analysis can help the PR-COIN sites and the collaborative prioritize efforts to optimize care and outcomes for children with JIA. This registry feature also helps sites stay engaged and encouraged as they can closely track the number of patients needed to achieve each goal. Network targets will continue to be adjusted based on measure performance.

Figure 1. PR-COIN network performance dashboard with ‘gap to target’ feature.

Figure 2. ‘Gap to target’ page showing quantitatively and visually if measure performance above or below the network target each month.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utilizing-a-gap-to-target-function-in-the-pediatric-rheumatology-care-and-outcomes-improvement-network-registry-dashboard-of-quality-measures/