Hospital clinical pathways for children affected by juvenile idiopathic arthritis

Area of Science:

• Pediatric Rheumatology
• Clinical Pathway Development
• Healthcare Management

Background:

• Juvenile idiopathic arthritis (JIA) is a chronic pediatric rheumatic disease requiring long-term management.
• Frequent relapses in JIA necessitate ongoing medical attention and can impact patient quality of life.
• Minimizing hospital admissions is crucial for maintaining a good quality of life for JIA patients.

Purpose of the Study:

• To develop and evaluate a Diagnostic Therapeutic Assistance Pathway (DTAP) for JIA patients.
• To identify JIA patients suitable for transfer from routine hospital care to day care or outpatient settings.
• To assess the potential reduction in hospitalizations through the implementation of DTAP.

Main Methods:

• A monocentric study analyzed JIA admissions between 2014-2016 at a university hospital in Milan.
• Medical records were reviewed, and data were collected in a Microsoft Excel database.
• A DTAP was designed based on data from the first year for patients with active arthritis and appropriate clinical conditions.

Main Results:

• The study included 223 JIA hospitalizations across 127 patients.
• Applying DTAP criteria indicated that 32% of patients could have avoided admission, and 23% could have been admitted less frequently.
• A notable decrease in JIA hospitalizations was observed since 2015, with numbers dropping from 89 in 2014 to 66 and 68 in 2015 and 2016, respectively.

Conclusions:

• The DTAP offers a feasible approach to modify hospitalization management for JIA patients.
• Implementing DTAP can facilitate non-hospitalized or minimized hospitalization treatment for children with JIA.
• Adopting DTAP is a priority for enhancing clinical practice and improving the quality of life for JIA patients and their families.