A Canadian Advanced Physiotherapist Practitioner Shared-Care Model in Pediatric Rheumatology Offers Safe and Quality Care in the Management of Juvenile Idiopathic Arthritis—Comparing Key Performance Indicators with the PR-COIN Registry

Abstract

Background/Objectives: Canadian Advanced Physiotherapist Practitioner (APP) roles have existed for over 25 years in pediatric rheumatology. The APP can manage many common pediatric rheumatic conditions most often in Shared-Care Models (SCMs) with pediatric rheumatologists (PRs). The quality of care children receive in an APP SCM compared to traditional care is unknown. The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) tracks quality measures as Key Performance Indicators (KPIs) in juvenile idiopathic arthritis (JIA) care. This study aimed to analyze the frequency of KPIs documented in a pediatric rheumatology APP SCM from a single center and compare to PR-COIN’s performance targets to assess the quality and safety of care. Methods: A retrospective chart review of JIA cases managed in a pediatric rheumatology APP SCM over a 2-year period was conducted. KPIs for disease activity, safety monitoring and access to care were evaluated. Frequency of KPI documentation by the APP were compared to target performance goals (≥40, ≥70 or ≥80% documentation rate depending on KPI) and with PR-COIN data from the Same Center (SC) (three rheumatologists) and PR-COIN (15 centers). Results: Documented KPIs were compared between the APP SCM, SC and PR-COIN registry (138; 140; 11,431 eligible visits, respectively) between June 2022–May 2024. Demographics were similar between groups. Increased percentages of patients with polyarticular rheumatoid factor positive and psoriatic subtypes were seen by APP compared to SC and PR-COIN. Documentation frequency of all disease activity and safety monitoring KPI performance goals were either higher in the APP SCM or comparable to SC and PR-COIN. Conclusions: The pediatric rheumatology APP SCM exceeded PR-COIN performance goals for KPI documentation, establishing a high level of quality and safety of care for children with JIA when managed in this model of care. Next steps include replicating this study in other pediatric rheumatology centers with an APP SCM.

Affiliated Institutions

• Seattle Children's Hospital US
• University of Missouri–Kansas City US
• London Health Sciences Centre CA
• McMaster Children's Hospital CA
• Penn State Milton S. Hershey Medical Center US
• Medical College of Wisconsin US
• Stanford University US
• Hackensack University Medical Center US
• Nationwide Children's Hospital US
• Hospital for Special Surgery US
• Levine Children's Hospital US
• University of Alabama at Birmingham US
• Cincinnati Children's Hospital Medical Center US
• Nemours Children's Clinic US
• The Ohio State University US
• Hackensack Meridian Health US
• Children's Mercy Hospital US
• Hamilton Health Sciences CA
• McMaster University CA
• Children's Hospital of Wisconsin US
• Wake Forest University US
• Medical University of South Carolina US
• Cohen Children's Medical Center US

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