Addressing Healthcare Quality in Juvenile Idiopathic Arthritis With a Universal Access Program
Bibliographic record
Abstract
In this issue of The Journal of Rheumatology , Concha, et al 1 describe the effects of the implementation, in 2010, of a national, legally mandated universal access program (Explicit Health Guarantees [GES]) for guaranteed juvenile idiopathic arthritis (JIA) diagnosis and treatment in Chile. The GES program guarantees that evaluation by a specialist takes place less than 30 days after referral from primary care, and that treatment must start no later than 7 days after confirmation of diagnosis. The authors report that this program led to earlier access to a pediatric rheumatologist and earlier JIA diagnosis. Diagnostic delay and time to evaluation by a pediatric rheumatologist were significantly reduced. Prior to GES, patients were evaluated and diagnosed 15 months after onset of symptoms vs 9 months post-GES. They found increased rates of treatment with biologic medications as well as increased magnetic resonance imaging (MRI) scans performed (9 vs 71). JIA remission rates, defined by Wallace criteria,2 were found to be higher (29% vs 43%) and uveitis complications rates lower (45% vs 13%).1 The GES was implemented in Chile in 2005. A 2015 World Health Organization (WHO) report on the system demonstrated improved efficiency in the Chilean healthcare system.3 The plan prioritizes and guarantees a number of issues or health conditions considered to be priorities (e.g., cancer, congenital heart diseases, high blood pressure, premature labor) based on people’s needs. The target group with each health condition has the right of access, with a defined maximum time for the delivery of the service; the right to financial protection, which regulates the co-payment according to the type of health insurance that the beneficiary may have; and the right to quality, which means receiving health care that is guaranteed by a registered provider who is accredited according to the law. The … Address correspondence to Dr. M. Batthish, Division of Rheumatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada. Email: batthim{at}mcmaster.ca.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.047 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.008 | 0.005 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.006 | 0.008 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".