PT - JOURNAL ARTICLE AU - Lisa Buckley AU - Eileen Ware AU - Genna Kreher AU - Lisa Wiater AU - Jay Mehta AU - Jon M. Burnham TI - Outcome Monitoring and Clinical Decision Support in Polyarticular Juvenile Idiopathic Arthritis AID - 10.3899/jrheum.190268 DP - 2019 Jul 15 TA - The Journal of Rheumatology PG - jrheum.190268 4099 - http://www.jrheum.org/content/early/2019/07/10/jrheum.190268.short 4100 - http://www.jrheum.org/content/early/2019/07/10/jrheum.190268.full AB - Objective Inconsistent assessment and treatment may negatively impact juvenile idiopathic arthritis (JIA) outcomes. We aimed to improve polyarticular JIA [Poly-JIA, rheumatoid factor positive and negative] outcomes by standardizing point-of-care disease activity monitoring and implementing clinical decision support (CDS) to reduce treatment variation. Methods We performed a quality improvement initiative in an outpatient pediatric rheumatology practice. The interventions, deployed from April-November 2016, included standardized disease activity measurement, disease activity target review, and phased introduction of Poly-JIA CDS to guide medication selection, dosing, treatment duration, and tapering. Process measures included visit-level target attestation (goal: 50%) and CDS use (goal: 15%). Our goal was to reduce the Poly-JIA clinical Juvenile Arthritis Disease Activity Score (cJADAS-10) by at least 10%. Included patients had at least two visits from April 2016 through July 2017, and were classified as having early (<6 months) or established disease (>6 months). Results 97 Poly-JIA patients (81% established disease) were observed for 10.3 months (IQR: 6.4-12.3). Target attestation and CDS use occurred in a mean of 77% and 45% of Poly-JIA visits, respectively. The median cJADAS-10 decreased significantly in both early (16.5 to 2.7, p<0.001) and established Poly-JIA (2.1 to 1.0, p=0.01). A high proportion of patients with early disease received biologic therapy (73.7%). In established disease, although non-biologic and biologic DMARD prescribing remained similar overall, adalimumab prescribing increased (12.8% to 23.1%, p=0.008). Conclusion Implementing structured disease activity monitoring and CDS in Poly-JIA were associated with significant reductions in disease activity scores in both early and established disease.