Evaluating Access to Care Indicators of JIA Patients in Southwestern Ontario
Bibliographic record
Abstract
Objectives Delays in initial consultation for patients with newly diagnosed juvenile idiopathic arthritis (JIA) are associated with worse outcomes.[1] Canadian benchmarks exist for acceptable wait times for initial consultation in JIA; non-systemic JIA patients should be seen within 4 weeks.[2] We sought to identify gaps in access to care in Ontario to plan for a province-wide quality improvement project. This study aimed to establish baseline measures for access to care indicators for patients with newly diagnosed JIA at pediatric rheumatology centers in Southwestern Ontario. Methods A retrospective chart review was completed for patients with non-systemic JIA assessed by Pediatric Rheumatology for consultation between January 1-June 30, 2024, at McMaster Children’s Hospital or Children’s Hospital, London Health Sciences Centre. Descriptive statistics were used to analyze wait times, patients meeting benchmarks, and general access to care measures. Results Twenty-one patients with newly diagnosed JIA were assessed during the first half of 2024. The median (IQR) wait time from referral to consultation was 16 days (IQR=9-30) and the 90th percentile wait time was 50 days. The wait time benchmark was achieved in 71.4% of patients with newly diagnosed JIA. There was regional variation in meeting the wait time benchmark between Hamilton (53.3%) and London (88.9%). No patients missed or rescheduled their initial consultation visit. Patients with newly diagnosed JIA saw a median of 2 medical providers prior to pediatric rheumatology. The average distance traveled to the pediatric rheumatology center was 55.6 km. The percentage of patients meeting the wait time benchmark were similar for those living within 25 km (85.7%), between 25-75 km (60%), and >75 km (75%). Conclusion Overall, the wait times for pediatric rheumatology consultation are reasonable for patients with newly diagnosed JIA; however, almost 30% of patients were not seen within the recommended benchmark. With the existing triage processes in Southwestern Ontario, patient distance from the care center did not seem to affect timely access to care. Regional variation exists between Pediatric Rheumatology sites and process mapping the triage workflow could help better understand factors contributing to these regional differences. Our next step will be the inclusion of the additional Pediatric Rheumatology academic centers in Ontario. A potential candidate for a province-wide quality improvement project is increasing the percentage of new JIA patients, currently 71.43%, being seen within the recommended wait time benchmark. [1.] McErlane F. Rheumatology (Oxford) 2016;55:1225-34. [2.] Barber C. J Rheumatolgoy 2016;43:530-40.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".