Juvenile idiopathic arthritis (JIA) is the most common pediatric chronic rheumatic disease, which requires constant follow-up over the years, due to relapses during its progression. To maintain a good quality of life, it is important to limit admissions as far as possible. With the development of a Diagnostic Therapeutic Assistance Pathway (DTAP), we aim to select patients with suitable clinical conditions to be moved from routine hospital management to day care or outpatient treatment, evaluating the number of patients to whom this would apply.
Monocentric study regarding admissions for JIA between 2014 and 2016 in a Pediatric Unit of a university hospital in Milan. Through an analysis of the medical records, relevant information was extracted and collected in a Microsoft™ Excel database; starting from the data collected during the first year, a DTAP was prepared for patients with active arthritis and appropriate clinical conditions.
The study includes data from 223 JIA hospitalization cases involving 127 patients. Applying DTAP criteria, 32% patients would have avoided admissions and 23% would have been admitted less frequently. The data concerning the activities of the Unit for JIA patients showed a relevant drop in the number of hospitalizations since 2015, from 89 in 2014 to 66 and 68 in 2015 and 2016 respectively.
The opportunity offered by DTAP, has suggested feasible changes in hospitalization management and it’s use would promote the possibility of treating the children without hospitalization, or minimizing it. In conclusion DTAP application is a priority for the continuous improvement of clinical practice and quality of life for patients and their families.
Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2. PubMed
Stanton B. St. Geme J, Schor NF, Behrman RE, Kliegman RM. Pediatria di Nelson. 19th ed. Elsevier-Masson: Milano; 2013.
Prakken B, Albani S, Martini A. Juvenile idiopathic arthritis. Lancet. 2011;377:2138–49. CrossRef
Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369:767–78. CrossRef
McErlane F, Foster HE, Carrasco R, Baildam EM, Chieng SE, Davidson JE, et al. Trends in paediatric rheumatology referral times and disease activity indices over a ten-year period among children and young people with juvenile idiopathic arthritis: results from the childhood arthritis prospective study. Rheumatology (Oxford). 2016;55:1225–34. CrossRef
Ostring GT, Singh-Grewal D. Juvenile idiopathic arthritis in the new world of biologics. J Paediatr Child Health. 2013;49(9):E405–12. CrossRef
Zulian F, Martini G, Gobber D, Plebani M, Zacchello F, Manners P. Triamcinolone acetonide and hexacetonide intra-articular treatment of symmetrical joints in juvenile idiopathic arthritis: a double-blind trial. Rheumatology (Oxford). 2004;43(10):1288–91. CrossRef
Papadopoulou C, Kostik M, Gonzalez-Fernandez MI, Bohm M, Nieto-Gonzalez JC, Pistorio A, et al. Delineating the role of multiple intraarticular corticosteroid injections in the management of juvenile idiopathic arthritis in the biologic era. Arthritis Care Res (Hoboken). 2013;65:1112–20. CrossRef
Stoll ML, Cron RQ. Treatment of juvenile idiopathic arthritis in the biologic age. Rheum Dis Clin N Am. 2013;39:751–66. CrossRef
Calvo I, Anton J, Lopez Robledillo JC, De Inocencio J, Gamir ML, Merino R, et al. Recommendations for the use of methotrexate in patients with juvenile idiopathic arthritis. An Pediatr (Barc). 2016;84(177):e1–8.
Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt EM, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken). 2011;63(4):465–82. CrossRef
Ringold S, Weiss PF, Colbert RA, DeWitt EM, Lee T, Onel K. Juvenile Idiopathic Arthritis Research Committee of the Childhood Arthritis and Rheumatology Research Alliance. Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for new-onset polyarticular juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2014;66:1063–72. CrossRef
Horneff G. Safety of biologic therapies for the treatment of juvenile idiopathic arthritis. Expert Opin Drug Saf. 2015;14(7):1111–26. CrossRef
Giancane G, Consolaro A, Lanni S, Davì S, Schiappapietra B, Ravelli A. Juvenile idiopathic arthritis: diagnosis and treatment. Rheumatol Ther. 2016;3:187–207. CrossRef
Kuhlmann A, Schmidt T, Treskova M, Lopez-Bastida J, Linertova R, Oliva-Moreno J, et al. BURQOL-RD Research Network. Social/economic costs and health-related quality of life in patients with juvenile idiopathic arthritis in Europe. Eur J Health Econ. 2016;17(Suppl 1):79–87. CrossRef
Lundberg V, Lindh V, Eriksson C, Petersen S, Eurenius E. Health-related quality of life in girls and boys with juvenile idiopathic arthritis: self and parental reports in a cross-sectional study. Pediatr Rheumatol Online J. 2017;10:33. CrossRef
Manczak M, Rutkowska-Sak L, Raciborski F. Health-related quality of life in children with juvenile idiopathic arthritis – child’s and parent’s point of view. Reumatologia. 2016;54:243–50. CrossRef
Sen ES, Morgan MJ, MacLeod R, Strike H, Hinchcliffe A, Dick AD, et al. Cross sectional, qualitative thematic analysis of patient perspectives of disease impact in juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J. 2017;15:58. CrossRef
Lail J, Schoettker PJ, White DL, Mehta B, Kotagal UR. Applying the chronic care model to improve care and outcomes at a pediatric medical center. Jt Comm J Qual Patient Saf. 2017;43:101–12. CrossRef
Adams JS, Wisk LE. Using the chronic care model to improve pediatric chronic illness care. Jt Comm J Qual Patient Saf. 2017;43:99–100. CrossRef
Tozzi VD. PDTA territoriali: specificità di metodo e di contenuto. In: AA.VV. PDTA standard per le patologie croniche. Milano: Egea spa; 2014.
Zuccotti GV, Giovannini M. Manuale di Pediatria-La pratica clinica. Società Editrice Esculapio: Bologna; 2012. CrossRef
Allen D, Gillen E, Rixson L. Systematic review of the effectiveness of integrated care pathways: what works, for whom, in which circumstances? Int J Evid Based Healthc. 2009;7:61–74. CrossRef
Greenacre M. Correspondence analysis in practice: Chapman and Hall; 2007.
Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80:27–38. CrossRef
R Core Team. R. A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2017. URL: https://www.R-project.org
- Hospital clinical pathways for children affected by juvenile idiopathic arthritis
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