Navigating the path to equitable rheumatologic care for underserved children with quality improvement.

Area of Science:

• Pediatric Rheumatology
• Quality Improvement Science
• Health Equity

Background:

• Underserved pediatric populations often face delayed or missed diagnoses of rheumatologic conditions.
• Safety-net primary care clinics serve families without private insurance, highlighting a need for improved access to specialist care.
• Early identification and intervention are crucial for managing pediatric rheumatologic diseases and preventing long-term complications.

Purpose of the Study:

• To implement a quality improvement project aimed at identifying children with rheumatologic conditions in underserved pediatric populations.
• To prevent delayed or missed diagnoses by optimizing the identification and referral processes within safety-net primary care clinics.
• To ensure prompt and accurate diagnosis and subsequent treatment of rheumatologic symptoms.

Main Methods:

• Collaboration with providers at a safety-net clinic to refine identification and subspecialty referral processes.
• Utilized the Model for Improvement framework with rapid Plan-Do-Study-Act (PDSA) cycles.
• Employed run and statistical process control charts for evaluating improvement in referral rates.

Main Results:

• Increased patient referrals for potential rheumatologic disease from zero in the prior 5 years to 15 within 1 year of project initiation.
• The rheumatology clinic successfully managed an increased referral volume, seeing all priority patients within 20 business days.
• Demonstrated a significant improvement in the identification and referral of pediatric patients with rheumatologic concerns.

Conclusions:

• Enhanced provider awareness of rheumatologic symptoms in safety-net settings is key.
• The use of visual aids and decision support tools facilitates efficient and accurate patient recognition and referral.
• Improved processes ensure timely access to pediatric rheumatology subspecialty care for vulnerable populations.