Determinants of disease activity change over time in Enthesitis related arthritis: effect of structured outcome monitori
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RESEARCH ARTICLE
Open Access
Determinants of disease activity change over time in Enthesitis related arthritis: effect of structured outcome monitoring and clinical decision support Francesca Tirelli1, Rui Xiao2, Timothy G. Brandon3, Jon M. Burnham4, Joyce C. Chang5 and Pamela F. Weiss5,6*
Abstract Background: We aimed to test if standardized point-of-care outcome monitoring and clinical decision support (CDS), as compared to standard care, improves disease activity and patient-reported pain in children with enthesitisrelated arthritis (ERA). Methods: This was a retrospective cohort study of outcomes of children with ERA after phased implementation of I) standardized outcome monitoring with CDS for polyarticular JIA, and II) CDS for ERA, compared to a preintervention group of historical controls. We used multivariable mixed-effects models for repeated measures to test whether implementation phase or other disease characteristics were associated with change over time in disease activity, as measured by the clinical juvenile arthritis disease activity score (cJADAS), and pain. Results: One hundred fifty-two ERA patients (41% incident cases) were included with a median age of 14.9 years. Implementation of standardized outcome monitoring or ERA-specific CDS did not result in significant differences in cJADAS or pain over time compared to the pre-intervention cohort. Higher cJADAS at the index visit, pain and more tender entheses were significantly associated with higher cJADAS scores over time (all p < 0.01), while biologic use was associated with lower cJADAS (p = 0.02). Regardless of intervention period, incident ERA cases had a greater rate of cJADAS improvement over time compared to prevalent cases (p < 0.01), but pain persisted over time among both incident and prevalent cases. Conclusions: There was no significant effect of point-of-care outcome monitoring or CDS interventions on disease activity or pain over time in children with ERA in this single center study. Future efforts to improve disease outcomes using standardized outcome monitoring and CDS will need to consider the importance of addressing pain as a target in addition to spondyloarthritis-specific disease activity metrics. Keywords: Ankylosing spondyloarthritis, juvenile idiopathic arthritis, Biologic therapy, Decision support systems, clinical
* Correspondence: [email protected] 5 Department of Pediatrics, Division of Rheumatology at the Children’s Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Wood Bldg 1st foor, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA 6 The Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 11121, Philadelphia, PA 19104, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution a
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