A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care

Barber, Claire; Twilt, Marinka; Pham, Tram; Currie, Gillian; Benseler, Susanne M.; Yeung, Rae S. M.; Batthish, Michelle; Blanchette, Nicholas; Guzman, Jaime; Lang, Bianca; LeBlanc, Claire; Levy, Deborah M.; O’Brien, Claire; Schmeling, Heinrike; Soon, Gordon S; Spiegel, Lynn; Whitney, Kristi; Marshall, Deborah

doi:10.1186/s13075-020-02151-w

Cited by 10 publications

(10 citation statements)

References 24 publications

(31 reference statements)

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“…Therefore, the overarching goal appears to have been to increase the quality of care to improve patient outcomes, although other potential benefits of reducing waiting times and freeing up physician time, which could translate to increased access have been acknowledged. Although access to care is increasingly identified as a key indicator of quality of care in the USA [48] and Canada [12,49], the potential benefits of the MCA go beyond increasing access to care. Secondly, although the MCA code was billed almost 45,000 times at a cost of nearly $10 m (CAD2016) during the study period, this does not represent the true cost of the intervention; the MCA code is a substitute for other codes, offering a premium for nursing care over standard, repeat or limited, or subsequent office visits, and paying less than extended consultations.…”

Section: Discussionmentioning

confidence: 99%

The impact of introducing multidisciplinary care assessments on access to rheumatology care in British Columbia: an interrupted time series analysis

Ross

Cheng

Law

et al. 2022

BMC Health Serv Res

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Background In 2011 the British Columbia (BC) Ministry of Health introduced a new fee-for-service billing code that allowed “Multidisciplinary Care Assessment” (MCA). This change has the potential to change access to and quality of care for patients. This study aimed to explore the impact on access to rheumatology services in the province. Methods Fee-for-service rheumatology billings were evaluated for each rheumatologist 2 years before and after use of the MCA code. Numbers of 1) unique patients and 2) services provided per month were used as proxy measures of access to care. A multiple-baseline interrupted time series model assessed the impact of the MCA on levels and trends of the access outcomes. Results Our analysis consisted of 82,360 patients cared for by 26 rheumatologists who billed for an MCA. In our primary analysis we observed a sustained increase in the mean number of unique patients of 4.9% (95% CI: 0.0% to 9.9%, p = 0.049) and the mean number of services of 7.1% (95% CI: 1.0% to 13.6%, (p = 0.021), per month provided by a rheumatologist, corresponding to the initial use of MCA. Conclusion The introduction of the MCA code was associated with an initial increase in the measures of access, which was maintained but did not increase over time. Our study suggests that the use of Multidisciplinary Care Assessment can contribute to expanding and/or sustaining access to care for people with complex chronic conditions, like rheumatic diseases.

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Section: Discussionmentioning

confidence: 99%

The impact of introducing multidisciplinary care assessments on access to rheumatology care in British Columbia: an interrupted time series analysis

Ross

Cheng

Law

et al. 2022

BMC Health Serv Res

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“…Much less information is available about the performance of the systems of care and how to optimise care delivery for children with JIA and their disease-related outcomes and quality of life (32). Various groups and organisations have proposed service delivery quality measures (11,33,34). In Germany, the newly developed guidelines for the treatment of children and adolescents with JIA (35) contain some statements on the desired quality of care (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Consequences of inadequate treatment include pain, disability due to joint deformities or damage, growth abnormalities, and psychological impacts (6,7). Therefore, timely access to holistic multidisciplinary care is a key performance indicator of paediatric rheumatology care (8)(9)(10)(11). However, wide variability in practice and care exists (12).…”

Section: Introductionmentioning

confidence: 99%

Consumer perspective on healthcare services for juvenile idiopathic arthritis: results of a multicentre JIA inception cohort study

Heinrich-Rohr

Mönkemöller

Niewerth

et al. 2021

Clinical and Experimental Rheumatology

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ObjectiveTo evaluate healthcare services for patients with juvenile idiopathic arthritis (JIA) from the parent-proxy perspective and to identify factors associated with perceived deficits in care. MethodsPatients with JIA from 11 paediatric rheumatology units were enrolled in an inception cohort within the first 12 months after diagnosis. Healthcare services were assessed using The Child Healthcare Questionnaire on satisfaction, utilisation and needs. Factors associated with deficits in care were identified by logistic regression analysis. ResultsData from parents of 835 JIA-patients were included in the analysis. At the assessment (4.7 months after diagnosis), 85% of the patients received drug treatment, and 50% had received multi-professional care. The most frequently used services were physiotherapy (84%), occupational therapy (23%), and telephone counselling (17%). Almost one-third of families reported that they had not received the services that they needed, with health education being the most frequently reported need. Most parents (93%) were satisfied with the overall healthcare provided for their children, especially regarding doctors' behaviour. However, approximately 1 in 3 consumers were dissatisfied with the time to JIA diagnosis and the school services.The lower the child's quality of life, the higher the chance was that the child and the family received multi-professional care, perceived unmet needs, and were dissatisfied with care. ConclusionAccording to parents' experience and satisfaction with their child's care, performance at the system level can be further improved by diagnosing JIA earlier, providing additional information at disease onset, and ensuring that the child's social environment is taken into account.

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“…Our prototype design encompasses the framework of having the right data at the right time to foster enhanced communication and collaboration during a clinical encounter and emphasizes the need for streamlined data collection to support multiple purposes and uses. Many of the dashboard data elements (functional status, pain score, patient global, joint count, and JADAS) were congruent with data collected within the CARRA [ 12 ] and PR-COIN [ 26 ] registries, as well as the Canadian JIA research network [ 33 ]. An opportunity exists to integrate these clinical care data with those required for research and quality improvement purposes.…”

Section: Discussionmentioning

confidence: 69%

Co-design of an Electronic Dashboard to Support the Coproduction of Care in Pediatric Rheumatic Disease: Human-Centered Design and Usability Testing

Taxter¹,

Johnson²,

Tabussi³

et al. 2022

J Particip Med

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Background The coproduction of care involves patients and families partnering with their clinicians and care teams, with the premise that each brings their own perspective, knowledge, and expertise, as well as their own values, goals, and preferences, to the partnership. Dashboards can display meaningful patient and clinical data to assess how a patient is doing and inform shared decision-making. Increasing communication between patients and care teams is particularly important for children with chronic conditions. Juvenile idiopathic arthritis (JIA), the most common chronic pediatric rheumatic condition, is associated with increased pain, decreased function, and decreased quality of life. Objective The aim of this study is to design a dashboard prototype for use in coproducing care in patients with JIA. We evaluated the use and needs of end users, obtained a consensus on the necessary dashboard data elements, and constructed display prototypes to inform meaningful discussions for coproduction. Methods A human-centered design approach involving parents, patients, clinicians, and care team members was used to develop a dashboard to support the coproduction of care in 4 ambulatory pediatric rheumatology clinics. We engaged a multidisciplinary team (n=18) of patients, parents, clinicians, nurses, and staff during an in-person kick-off meeting followed by biweekly meetings. We also leveraged advisory panels. Teams mapped workflows and patient journeys, created personas, and developed dashboard sketches. The final dashboard components were determined via Delphi consensus voting. Low-tech dashboard testing was completed during clinic visits, and visual display prototypes were iterated by using the Plan-Do-Study-Act methodology. Patients and clinicians were surveyed regarding their experiences. Results Teams achieved consensus on what data mattered most at the point of care to support patients with JIA, families, and clinicians collaborating to make the best possible health care decisions. Notable themes included the right data in the right place at the right time, data in once for multiple purposes, patient and family self-management components, and the opportunity for education and increased transparency. A final set of 11 dashboard data elements was identified, including patient-reported outcomes, clinical data, and medications. Important design considerations featured the incorporation of real-time data, clearly labeled graphs, and vertical orientation to facilitate review and discussion. Prototype paper-testing with 36 patients and families yielded positive feedback, with 89% (8/9) to 100% (9/9) of parents (n=9) and 80% (8/10) to 90% (9/10) of clinicians (n=10) strongly agreeing or agreeing that the dashboard was useful during clinic discussions, helped to talk about what mattered most, and informed health care decision-making. Conclusions We developed a dashboard prototype that displays patient-reported and clinical data over time, along with medications that can be used during a clinic visit to support meaningful conversations and shared decision-making among patients with JIA, their families, and their clinicians and care teams.

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A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care

Cited by 10 publications

References 24 publications

The impact of introducing multidisciplinary care assessments on access to rheumatology care in British Columbia: an interrupted time series analysis

The impact of introducing multidisciplinary care assessments on access to rheumatology care in British Columbia: an interrupted time series analysis

Consumer perspective on healthcare services for juvenile idiopathic arthritis: results of a multicentre JIA inception cohort study

Co-design of an Electronic Dashboard to Support the Coproduction of Care in Pediatric Rheumatic Disease: Human-Centered Design and Usability Testing

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