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Lee JJY, Laxer RM, Feldman BM, Barber CEH, Batthish M, Berard R, Tucker LB, Levy DM. Variations in Pediatric Rheumatology Workforce and Care Processes Across Canada. J Rheumatol 2021; 49:197-204. [PMID: 34334367 DOI: 10.3899/jrheum.201611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine Canadian pediatric rheumatology workforce and care processes. METHODS Pediatric rheumatologists and allied health professionals (AHPs) participated. A designee from each academic centre provided workforce information including number of providers, total and breakdown of full-time equivalents (FTE), and triage processes. We calculated the clinical care FTE (cFTE) available per 75,000 (recommended benchmark) and 300,000 (adjusted) children using 2019 census data. The national workforce deficit was calculated as the difference between current and expected cFTEs. Remaining respondents were asked about ambulatory practices. RESULTS The response rate of survey A (workforce information) and survey B (ambulatory practice information) was 100% and 54%, respectively. The majority of rheumatologists (91%) practiced in academic centres. The median number of rheumatologists per centre was 3 (IQR:3) and median cFTE was 1.8 (IQR:1.5). The median cFTE per 75,000 was 0.2 (IQR:0.3) with a national deficit of 80 cFTEs. With the adjusted benchmark, there was no national deficit but a regional maldistribution of rheumatologists. All centres engaged in multidisciplinary practices with a median of 4 different AHPs, although the median FTE for AHPs was ≤1. Most centres (87%) utilized a centralized triage process. Of 9 (60%) centres that used an electronic triage process, 6 were able to calculate wait times. Most clinicians integrated quality improvement practices, such as pre-visit planning (68%), post-visit planning (68%), and periodic health outcome monitoring (36-59%). CONCLUSION This study confirms a national deficit at the current recommended benchmark. Most rheumatologists work in multidisciplinary teams, but AHP support may be inadequate.
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Affiliation(s)
- Jennifer J Y Lee
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Ronald M Laxer
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Brian M Feldman
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Claire E H Barber
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Michelle Batthish
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Roberta Berard
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Lori B Tucker
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
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Deng J, Chalhoub NE, Sherwin CM, Li C, Brunner HI. Glucocorticoids pharmacology and their application in the treatment of childhood-onset systemic lupus erythematosus. Semin Arthritis Rheum 2019; 49:251-259. [PMID: 30987856 DOI: 10.1016/j.semarthrit.2019.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 12/17/2022]
Abstract
Glucocorticoids are potent anti-inflammatory and immunosuppressant medications and remain the mainstay of systemic lupus erythematosus (SLE) therapy. The potency of a specific glucocorticoid, i.e., the dose of glucocorticoid that is required to produce a specific effect, is dependent on its pharmacokinetic (PK) and pharmacodynamic (PD) properties. In this review, we summarize the PK/PD properties of commonly used glucocorticoids in an attempt to better delineate their role in the management of children with childhood-onset SLE (cSLE). We also address glucocorticoid side effects as these play a major role when deciding on the dose, frequency, and duration of use. A better understanding of the pharmacology of glucocorticoids appears useful to achieve improved outcomes in the management of cSLE.
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Affiliation(s)
- Jianghong Deng
- Department of Rheumatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China; Division of Rheumatology, Cincinnati Children's Hospital Medical Center, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Nathalie E Chalhoub
- Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Catherine M Sherwin
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Caifeng Li
- Department of Rheumatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China.
| | - Hermine I Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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El Miedany Y, El Gaafary M, Lotfy H, El Aroussy N, Mekkawy D, Nasef SI, Elderiny G, Farag Y, Hassan M. Facilitating patient-centered care: the development of illustrated multidimensional patient-reported outcome measures for children/adolescents with juvenile idiopathic arthritis. Clin Rheumatol 2019; 38:2219-2226. [PMID: 30834997 DOI: 10.1007/s10067-019-04490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To assess the validity, reliability, comprehensibility, and responsiveness to change of an illustrated child/parent multidimensional patient-reported outcome measures (PROMs) questionnaire which can assess construct outcome measures of children with juvenile inflammatory arthritis. METHODS A total of 122 children with juvenile idiopathic arthritis were included in this work in a multicenter study. The questionnaire included seven categories: (1) functional ability; (2) health-related quality of life; (3) disease activity measures: pain, global assessment, fatigue, and morning stiffness; (4) self-reported joint tenderness; (5) current medication, side effects, and adherence to therapy; (6) comorbidities; and (7) patient motivation. All the items were supported by illustrations to provide children with a visual impression of what was meant by the questions. The questionnaire has parent and patient versions. The disease activity status was assessed using JADAS-27. RESULTS The questionnaire was reliable as demonstrated by a high-standardized alpha (0.890-0.978). The questionnaire items correlated significantly (p < 0.01) with clinical parameters of disease activity. The patient-reported tender joints correlated significantly with the physician's scores (0.842). Changes in functional disability, quality of life, and the motivation score showed significant variation (p < 0.01) with disease activity status in response to therapy. The illustrated PROMs questionnaire showed also a high degree of comprehensibility (9.6). CONCLUSIONS Integrating PROMs into standard clinical practice is feasible and applicable. The illustrated questionnaire was valid and reliable. It provides an informative, quantitative measure for the disease activity score set data, and in the meantime, facilitates the assessment of the children's adherence to therapy, comorbidities, and motivation on an individual basis.
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Affiliation(s)
- Yasser El Miedany
- Rheumatology and Rehabilitation, School of Medicine, Ain Shams University, Cairo, Egypt. .,Rheumatology, Darent Valley Hospital, Dartford, Kent, England, DA2 8DA, UK.
| | - M El Gaafary
- Community and Public Health, School of Medicine, Ain Shams University, Cairo, Egypt
| | - H Lotfy
- Pediatrics, School of Medicine, Cairo University, Cairo, Egypt
| | - N El Aroussy
- Rheumatology and Rehabilitation, School of Medicine, Ain Shams University, Cairo, Egypt
| | - D Mekkawy
- Rheumatology and Rehabilitation, School of Medicine, Ain Shams University, Cairo, Egypt
| | - S I Nasef
- Rheumatology and Rehabilitation, School of Medicine, Suez Canal University, Ismaillia, Egypt
| | - G Elderiny
- Pediatrics, School of Medicine, Alexandria University, Alexandria, Egypt
| | - Y Farag
- Pediatrics, School of Medicine, Cairo University, Cairo, Egypt
| | - M Hassan
- Rheumatology and Rehabilitation, Tanta University, Tanta, Egypt
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Hinze CH, Holzinger D, Lainka E, Haas JP, Speth F, Kallinich T, Rieber N, Hufnagel M, Jansson AF, Hedrich C, Winowski H, Berger T, Foeldvari I, Ganser G, Hospach A, Huppertz HI, Mönkemöller K, Neudorf U, Weißbarth-Riedel E, Wittkowski H, Horneff G, Foell D. Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany. Pediatr Rheumatol Online J 2018; 16:7. [PMID: 29357887 PMCID: PMC5778670 DOI: 10.1186/s12969-018-0224-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/12/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Systemic juvenile idiopathic arthritis (SJIA) is an autoinflammatory disease associated with chronic arthritis. Early diagnosis and effective therapy of SJIA is desirable, so that complications are avoided. The PRO-KIND initiative of the German Society for Pediatric Rheumatology (GKJR) aims to define consensus-based strategies to harmonize diagnostic and therapeutic approaches in Germany. METHODS We analyzed data on patients diagnosed with SJIA from 3 national registries in Germany. Subsequently, via online surveys and teleconferences among pediatric rheumatologists with a special expertise in the treatment of SJIA, we identified current diagnostic and treatment approaches in Germany. Those were harmonized via the formulation of statements and, supported by findings from a literature search. Finally, an in-person consensus conference using nominal group technique was held to further modify and consent the statements. RESULTS Up to 50% of patients diagnosed with SJIA in Germany do not fulfill the International League of Associations for Rheumatology (ILAR) classification criteria, mostly due to the absence of chronic arthritis. Our findings suggest that chronic arthritis is not obligatory for the diagnosis and treatment of SJIA, allowing a diagnosis of probable SJIA. Malignant, infectious and hereditary autoinflammatory diseases should be considered before rendering a diagnosis of probable SJIA. There is substantial variability in the initial treatment of SJIA. Based on registry data, most patients initially receive systemic glucocorticoids, however, increasingly substituted or accompanied by biological agents, i.e. interleukin (IL)-1 and IL-6 blockade (up to 27.2% of patients). We identified preferred initial therapies for probable and definitive SJIA, including step-up patterns and treatment targets for the short-term (resolution of fever, decrease in C-reactive protein by 50% within 7 days), the mid-term (improvement in physician global and active joint count by at least 50% or a JADAS-10 score of maximally 5.4 within 4 weeks) and the long-term (glucocorticoid-free clinically inactive disease within 6 to 12 months), and an explicit treat-to-target strategy. CONCLUSIONS We developed consensus-based strategies regarding the diagnosis and treatment of probable or definitive SJIA in Germany.
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Affiliation(s)
- Claas H. Hinze
- 0000 0004 0551 4246grid.16149.3bDepartment of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Albert-Schweitzer-Campus 1, Building W30, 48149 Münster, Germany
| | - Dirk Holzinger
- 0000 0004 0551 4246grid.16149.3bDepartment of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Albert-Schweitzer-Campus 1, Building W30, 48149 Münster, Germany ,0000 0001 2187 5445grid.5718.bDepartment of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Elke Lainka
- 0000 0001 0262 7331grid.410718.bDepartment of Pediatrics, University Hospital Essen, Essen, Germany
| | - Johannes-Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Fabian Speth
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Tilmann Kallinich
- 0000 0001 2218 4662grid.6363.0Department of Pediatric Pulmonology and Immunology, Charité, Berlin, Germany
| | - Nikolaus Rieber
- Department of Pediatrics, StKM GmbH and Technical University Muenchen, Munich, Germany ,0000 0001 2190 1447grid.10392.39The Department of Pediatrics I, University of Tuebingen, Tuebingen, Germany
| | - Markus Hufnagel
- 0000 0000 9428 7911grid.7708.8Department of Pediatrics, University Hospital Freiburg, Freiburg, Germany
| | - Annette F. Jansson
- 0000 0004 0477 2585grid.411095.8Division of Pediatric Rheumatology & Immunology, Dr. von Hauner Children’s Hospital, University Hospital Munich, Munich, Germany
| | - Christian Hedrich
- 0000 0001 1091 2917grid.412282.fDepartment of Pediatrics, University Hospital Dresden, Dresden, Germany ,0000 0004 1936 8470grid.10025.36Department of Women’s & Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK ,0000 0004 0421 1374grid.417858.7Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool, UK
| | - Hanna Winowski
- grid.416438.cDepartment of Pediatric Rheumatology, St. Josef Hospital, Sendenhorst, Germany
| | | | - Ivan Foeldvari
- Hamburg Center for Pediatric and Adolescent Rheumatology, Hamburg, Germany
| | - Gerd Ganser
- grid.416438.cDepartment of Pediatric Rheumatology, St. Josef Hospital, Sendenhorst, Germany
| | - Anton Hospach
- Department of Pediatrics, Olga Hospital, Stuttgart, Germany
| | - Hans-Iko Huppertz
- Department of Pediatrics, Prof. Hess Children’s Hospital, Bremen, Germany
| | | | - Ulrich Neudorf
- 0000 0001 0262 7331grid.410718.bDepartment of Pediatrics, University Hospital Essen, Essen, Germany
| | | | - Helmut Wittkowski
- 0000 0004 0551 4246grid.16149.3bDepartment of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Albert-Schweitzer-Campus 1, Building W30, 48149 Münster, Germany
| | - Gerd Horneff
- Department of Pediatrics, Asklepios Hospital, St. Augustin, Germany ,0000 0000 8580 3777grid.6190.eUniversity of Cologne, Cologne, Germany
| | - Dirk Foell
- 0000 0004 0551 4246grid.16149.3bDepartment of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Albert-Schweitzer-Campus 1, Building W30, 48149 Münster, Germany
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Consolaro A, Giancane G, Schiappapietra B, Davì S, Calandra S, Lanni S, Ravelli A. Clinical outcome measures in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2016; 14:23. [PMID: 27089922 PMCID: PMC4836071 DOI: 10.1186/s12969-016-0085-5] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/07/2016] [Indexed: 11/30/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA), as a chronic condition, is associated with significant disease- and treatment-related morbidity, thus impacting children's quality of life. In order to optimize JIA management, the paediatric rheumatologist has begun to regularly use measurements of disease activity developed, validated and endorsed by international paediatric rheumatology professional societies in an effort to monitor the disease course over time and assess the efficacy of therapeutic interventions in JIA patients.A literature review was performed to describe the main outcome measures currently used in JIA patients to determine disease activity status.The Juvenile Disease Activity Score (JADAS), in its different versions (classic JADAS, JADAS-CRP and cJADAS) and the validated definitions of disease activity and response to treatment represent an important tool for the assessment of clinically relevant changes in disease activity, leading more and more to a treat-to-target strategy, based on a tight and thorough control of the patient condition. Moreover, in recent years, increasing attention on the incorporation of patient-reported or parent-reported outcomes (PRCOs), when measuring the health state of patients with paediatric rheumatic diseases has emerged.We think that the care of JIA patients cannot be possible without taking into account clinical outcome measures and, in this regard, further work is required.
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Affiliation(s)
- Alessandro Consolaro
- Istituto Giannina Gaslini, Genova, Italy. .,Università degli Studi di Genova, Genova, Italy.
| | | | | | | | | | | | - Angelo Ravelli
- Istituto Giannina Gaslini, Genova, Italy ,Università degli Studi di Genova, Genova, Italy
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Abstract
PURPOSE OF REVIEW This article highlights efforts in pediatric rheumatology related to optimizing the care provided to patients with pediatric rheumatic diseases and describes various approaches to improve health outcomes. RECENT FINDINGS Recent studies report low rates of remission, frequent occurrence of comorbidities, disease damage, and decreased health-related quality of life in pediatric rheumatic diseases. The Pediatric Rheumatology Care and Outcomes Improvement Network is a quality improvement learning network that has demonstrated improvement in the process of care measures through use of a centralized patient registry, and interventions, including previsit planning, population management, shared decision making, and patient/parent engagement. A pediatric rheumatology patient-powered research network was established to enable patient and caregiver participation in setting research priorities and to facilitate data sharing to answer research questions. Quality measure development and benchmarking are proceeding in multiple pediatric rheumatic diseases. SUMMARY The review summarizes the current efforts to improve care delivery and outcomes in pediatric rheumatic diseases through a learning health system approach that harnesses knowledge from the clinical encounter to serve quality improvement, research, and discovery. Incorporating standard approaches to medication treatment plans may reduce variation in care, including using the patient voice to design research studies to bring focus on more patient relevant outcomes. VIDEO ABSTRACT http://links.lww.com/COR/A28.
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Affiliation(s)
| | | | - Esi M. Morgan
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- University of Cincinnati College of Medicine, Cincinnati, OH
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Hollander MC, Sage JM, Greenler AJ, Pendl J, Avcin T, Espada G, Beresford MW, Henrickson M, Lee TL, Punaro M, Huggins J, Stevens AM, Klein-Gitelman MS, Brunner HI. International Consensus for Provisions of Quality-Driven Care in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2013; 65:1416-23. [DOI: 10.1002/acr.21998] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/21/2013] [Indexed: 01/22/2023]
Affiliation(s)
| | - Jessica M. Sage
- Cincinnati Children's Hospital Medical Center; Cincinnati; Ohio
| | | | - Joshua Pendl
- Cincinnati Children's Hospital Medical Center; Cincinnati; Ohio
| | - Tadej Avcin
- University Children's Hospital; Ljubljana; Slovenia
| | - Graciela Espada
- Hospital de Niños Ricardo Gutierrez; Buenos Aires; Argentina
| | - Michael W. Beresford
- University of Liverpool, Alder Hey Children's NHS Foundation Trust; Liverpool; UK
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Kuske S, Maass C, Weingärter V, Pöhlmann S, Schrappe M. Patient-safety indicators: a systematic review, criteria-based characterization and prioritization. J Public Health (Oxf) 2012. [DOI: 10.1007/s10389-012-0532-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Berard R, Laxer RM. Improving the quality of care in children with juvenile idiopathic arthritis: a step in the right direction. J Rheumatol 2011; 38:789-90. [PMID: 21532058 DOI: 10.3899/jrheum.110047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Miller ML, Ruprecht J, Wang D, Zhou Y, Lales G, McKenna S, Klein-Gitelman M. Physician assessment of disease activity in JIA subtypes. Analysis of data extracted from electronic medical records. Pediatr Rheumatol Online J 2011; 9:9. [PMID: 21492466 PMCID: PMC3089777 DOI: 10.1186/1546-0096-9-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 04/14/2011] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Although electronic medical records (EMRs) have facilitated care for children with juvenile idiopathic arthritis (JIA), analyses of treatment outcomes have required paper based or manually re-entered data. We have started EMR discrete data entry for JIA patient visits, including joint examination and global assessment, by physician and patient. In this preliminary study, we extracted data from the EMR to Xenobase™ (TransMed Systems, Inc., Cupertino, CA), an application permitting cohort analyses of the relationship between global assessment to joint examination and subtype. METHODS During clinic visits, data were entered into discrete fields in ambulatory visit forms in the EMR (EpicCare™, Epic Systems, Verona, WI). Data were extracted using Clarity Reports, then de-identified and uploaded for analyses to Xenobase™. Parameters included joint examination, ILAR diagnostic classification, physician global assessment, patient global assessment, and patient pain score. Data for a single visit for each of 160 patients over a 2 month period, beginning March, 2010, were analyzed. RESULTS In systemic JIA patients, strong correlations for physician global assessment were found with pain score, joint count and patient assessment. In contrast, physician assessment for patients with persistent oligoarticular and rheumatoid factor negative patients showed strong correlation with joint counts, but only moderate correlation with pain scores and patient global assessment. Conversely, for enthesitis patients, physician assessment correlated strongly with pain scores, and moderately with joint count and patient global assessment. Rheumatoid factor positive patients, the smallest group studied, showed moderate correlation for all three measures. Patient global assessment for systemic patients showed strong correlations with pain scores and joint count, similar to data for physician assessment. For polyarticular and enthesitis patients, correlation of patient global assessment with pain scores was strong. Moderate correlations were found between patient global assessment and joint count in oligoarticular and polyarticular patients. CONCLUSION Data extraction from the EMR is feasible and useful to evaluate JIA patients for indicators of treatment responsiveness. In this pilot study, we found correlates for physician global assessment of arthritis differed, according to disease subtype. Further data extraction and analyses will determine if these findings can be confirmed, and will assess other outcome measures, compare longitudinal responses to treatment, and export extracted data to multi-center databases.
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Affiliation(s)
- Michael L Miller
- Division of Rheumatology, Department of Pediatrics; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Jason Ruprecht
- Children's Memorial Research Center (CMRC), Children's Memorial Hospital, Chicago, IL, USA,Department of Information Technology, CMRC, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Deli Wang
- Children's Memorial Research Center (CMRC), Children's Memorial Hospital, Chicago, IL, USA,Biostatistical Research Core, CMRC; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ying Zhou
- Children's Memorial Research Center (CMRC), Children's Memorial Hospital, Chicago, IL, USA,Biostatistical Research Core, CMRC; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - George Lales
- Children's Memorial Research Center (CMRC), Children's Memorial Hospital, Chicago, IL, USA,Department of Information Technology, CMRC, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sean McKenna
- Children's Memorial Research Center (CMRC), Children's Memorial Hospital, Chicago, IL, USA,Department of Information Technology, CMRC, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marisa Klein-Gitelman
- Division of Rheumatology, Department of Pediatrics; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Children's Memorial Research Center (CMRC), Children's Memorial Hospital, Chicago, IL, USA
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Lovell DJ, Passo MH, Beukelman T, Bowyer SL, Gottlieb BS, Henrickson M, Ilowite NT, Kimura Y, DeWitt EM, Segerman J, Stein LD, Taylor J, Vehe RK, Giannini EH. Measuring process of arthritis care: a proposed set of quality measures for the process of care in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2011; 63:10-6. [PMID: 20842714 DOI: 10.1002/acr.20348] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The ability to assess quality of care is a necessary component of continuous quality improvement. The assessment typically is accomplished by determination of compliance with a defined set of quality measures (QMs). The objective of this effort was to establish a set of QMs for the assessment of the process of care in juvenile idiopathic arthritis (JIA). METHODS A 12-member working group composed of representatives from the American College of Rheumatology, American Academy of Pediatrics, American Board of Pediatrics, and Association of Rheumatology Health Professionals was assembled to guide the project. Delphi questionnaires were sent to 237 health professionals involved in the care of children with JIA. A total of 471 items in 23 domains were identified. The working group met via 4 live e-meetings during which results from the Delphi questionnaires were distilled to a reduced draft set. Each working group member selected a proposed QM to investigate and present evidence from the literature as to its attributes and appropriateness for inclusion into the set. Nominal group technique was used to come to consensus on a proposed set of QMs. RESULTS The proposed set contains 12 QMs within 4 health care domains. Each QM consists of a statement of 1) the assessment to be completed, 2) when the first assessment should be completed and a suggested frequency of assessment during followup, 3) recommendations of appropriate tools or methods of assessment, and 4) initial performance goals. CONCLUSION Implementation of the proposed QM set will improve the process of care, facilitate continuous quality improvement, and eventuate in improved health outcomes of children with JIA.
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Affiliation(s)
- Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Patel AM, Torok KS, Rosen P. Improvement in medication education in a pediatric subspecialty practice. Pediatr Rheumatol Online J 2010; 8:25. [PMID: 20843355 PMCID: PMC2949753 DOI: 10.1186/1546-0096-8-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 09/15/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to measure the impact of an educational intervention on parents of children taking methotrexate (MTX) for juvenile idiopathic arthritis (JIA). METHODS This study was conducted using a pre- and postsurvey design. The parents of 100 children with JIA taking MTX for at least 2 months were surveyed during a routine office visit. The parents completed an initial questionnaire regarding the safe use, adverse effects, and guidelines for monitoring the toxicity of MTX. An educational intervention was then administered, and an identical follow-up questionnaire was given during the next office visit. Statistical analysis using a paired t-test (critical P value < 0.05) was performed on individuals who answered both questionnaires. RESULTS There were 100 responses to the initial questionnaire and 67 responses to the follow-up questionnaire. The mean length of time between surveys was 2.9 ± 0.9 months. In those who completed both questionnaires, the overall correct score increased significantly from 75.8% to 93.4%, respectively (P < 0.0001). Individuals scored the lowest (49%) on the question that addressed MTX's impact on pregnancy and fertility. CONCLUSIONS MTX knowledge may be less than expected in the parents of children with JIA. Brief educational interventions in the pediatric subspecialty practice can significantly affect a family's understanding of their child's medications.
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Affiliation(s)
- Aarat M Patel
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, S700 BST, 3500 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Kathryn S Torok
- Division of Pediatric Rheumatology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
| | - Paul Rosen
- Division of Pediatric Rheumatology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Groah SL, Libin A, Lauderdale M, Kroll T, DeJong G, Hsieh J. Beyond the evidence-based practice paradigm to achieve best practice in rehabilitation medicine: a clinical review. PM R 2009; 1:941-50. [PMID: 19797005 DOI: 10.1016/j.pmrj.2009.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 05/08/2009] [Accepted: 06/01/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Best practice is a practice that, on rigorous evaluation, demonstrates success, has had an impact, and can be replicated. It is differentiated from its constituent parts, evidence-based practice and knowledge translation, by its general meaning and global purview. The purpose of this clinical review is to provide transparency to the concept and achievement of best practice in the context of rehabilitation medicine. The authors will review and analyze the roles of evidence-based practice and knowledge translation in rehabilitation medicine as they work to support best practice. Challenge areas will be discussed, including an evidential hierarchy in need of update, a lack of "high-level" research evidence, and delays in translating evidence to practice. Last, the authors will argue that rehabilitation medicine is well-positioned to effect change by promoting inclusion of emerging research methodologies and analytic techniques that better capture context-specific rehabilitation evidence, into the evidential hierarchy. Achieving best practice is dependent on this, as well as alignment of all key stakeholders, ranging from the patient, researchers and clinicians, to policymakers, payers, and others.
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Affiliation(s)
- Suzanne L Groah
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Hospital, Washington, DC 20010, USA.
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