An Advanced Physiotherapist Practitioner’s Level of Safety Performing Juvenile Idiopathic Arthritis Care (Applejac) - Comparing Key Performance Indicators with the PR-COIN Registry
Bibliographic record
Abstract
Objectives The advanced physiotherapist practitioner (APP) model of care (MOC) has existed for 20 years in Canada in pediatric rheumatology.[1] The APP manages children with juvenile idiopathic arthritis (JIA) in shared care models with pediatric rheumatologists. The extent to which the quality of care these children receive from an APP compared to a physician is unknown. The PR-COIN network tracks quality, safety and access key performance indicators (KPIs) in JIA care.[2] This study aimed to analyze the frequency and outcomes of KPI’s documented in an APP MOC for management of JIA, and compare these findings to PR-COIN to assess quality, safety and access of care. Methods A retrospective chart review of JIA cases managed by 1 APP at a tertiary pediatric rheumatology clinic between June 2022 to May 2024 was conducted. Quality KPIs included active joint count, pain score, physician and patient global assessment, cJADAS, physical function and QoL measures. Safety KPIs included TB and uveitis screening, and lab monitoring. Access was measured by documentation of at least 1 visit in 12 months.[2,3] Documented frequency of KPIs and their outcomes by the APP were compared with PR-COIN data from same center (SC) (3 rheumatologists) and PR-COIN (16 centers). Results The APP saw 33 unique patients with 1-8 visits each totaling 138 eligible visits. The SC saw 73 unique patients and PR-COIN saw 4,297 for a total of 151 and 12,162 eligible visits respectively. Gender (F:61-69%) was similar among all groups; Mean (SD) age of patients with APP was 9.3 years (4.7), SC 12.4 (4.5) and PR-COIN 13.3 (5.1). Most common JIA subtype for all groups was oligoarticular persistent (26-33%). 9.1% of patients seen by the APP had Polyarticular RF+ compared to SC and PR-COIN (1.6%,5.0%). 18% of patients seen by the APP had Psoriatic Arthritis compared to SC and PR-COIN (1.7%;9.2%). All KPI frequency thresholds were exceeded in the APP cohort and were comparable or higher to other groups (Table 1). Cases achieving low disease activity (cJADAS <3) was 55% for the APP and (74.4%;63.2%) for SC and PR-COIN, respectively. The APP had 71% of visits with pain rating of <1 compared to the SC and PR-COIN (69%;56%). Table 1 Thresholds of Key Performance Indicators in Juvenile Idiopathic Arthritis care compared to documented frequency of APP MOC, Same Center care and PRCOIN registry Conclusion The pediatric rheumatology APP MOC meets and exceeds quality, safety and access standards of care with comparable outcomes to JIA care by pediatric rheumatologists. Next steps include replicating this study in other pediatric rheumatology centers with an APP MOC. [1.] Lundon K. ACR Open Rheumatol 2020;2(4):242-50. [2.] Lovell DJ. Arthritis Care Res (Hoboken) 2011;63(1):10-6. [3.] Cooper SM. Pediatr Rheumatol Online J 2023;21(1):37.
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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 | 0.008 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".