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 - 2020 Feb 01 TA - The Journal of Rheumatology PG - 273--281 VI - 47 IP - 2 4099 - http://www.jrheum.org/content/47/2/273.short 4100 - http://www.jrheum.org/content/47/2/273.full SO - J Rheumatol2020 Feb 01; 47 AB - Objective. Inconsistent assessment and treatment may impair juvenile idiopathic arthritis (JIA) outcomes. We aimed to improve polyarticular 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, implemented from April to November 2016, included standardized disease activity measurement, disease activity target review, and phased introduction of polyarticular 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 polyarticular JIA clinical Juvenile Arthritis Disease Activity Score (cJADAS-10) by at least 10%. Included patients had at least 2 visits from April 2016 through July 2017, and were classified as having early (≤ 6 mos) or established disease (> 6 mos).Results. Patients with polyarticular JIA (n = 97; 81% established disease) were observed for 10.3 months (interquartile range: 6.4–12.3). Target attestation and CDS use occurred in a mean of 77% and 45% of polyarticular JIA visits, respectively. The median cJADAS-10 decreased significantly in both early (16.5 to 2.7, p < 0.001) and established polyarticular 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 prescription of nonbiologic and biologic disease-modifying antirheumatic drugs remained similar overall, adalimumab prescribing increased (12.8% to 23.1%, p = 0.008).Conclusion. Implementation of structured disease activity monitoring and CDS in polyarticular JIA was associated with significant reductions in disease activity scores in both early and established disease.