Joint destruction can begin at any age, but it can take years for the damage to present itself in children, so the learning network helps ensure they get the best help possible.

With the patient’s consent, team members at each of PR-COIN's 12 sites collect all kinds of data from how many joints are affected, to pain levels, to the last time the patient had a laboratory test, or saw the ophthalmologist. Then, Dr. Morgan DeWitt’s team collects the data and makes charts that show, over time, how effectively the health care teams are performing in certain important areas of care. Once a month, the teams talk over the results via phone conferences.

Tracking patient data in such a manner helps teams develop ways to pull together everything needed to care for children with JIA, down to improving communication with eye doctors and primary care physicians. Sharing results matters, says Dr. Morgan DeWitt, because all network members are dedicated to improving care. When one site is doing well, that team helps others by sharing successful tactics. Discussing experience and what works is where the learning happens – both within individual sites and across the network.

"A lot of teams already have good practices in place but they may not always use them consistently,” says Dr. Morgan DeWitt. “By virtue of sharing this information that conversation happens, and you can learn from one another."

Now that PR-COIN is up and running at 12 sites, Dr. Morgan DeWitt hopes to expand the network to include additional centers. Her team is also working on a population management tool that will help rheumatologists monitor treatments for individual patients and see who is doing well, or find out which patients are not doing as well and may need a change in treatment. Also, as most chronic illnesses are managed at home, PR-COIN is eager to add online tools to support patients and caregivers and involve them in PR-COIN activities.

Just as caring for children with JIA needs a team of health care professionals, Dr. Morgan DeWitt relied on teamwork to pull PR-COIN together. The American College of Rheumatology provided support for the electronic database. Funding came from the Arthritis Foundation, the Cincinnati Children’s Hospital Medical Center via the Agency for Healthcare Research, which matched the Arthritis Foundation grant, and from an anonymous donor.

Dr. Morgan DeWitt credits the Arthritis Foundation with getting the funding, and thus the quality improvement  learning network off the ground. “The Arthritis Foundation took a risk on our project. It’s a compelling idea but this type of project is difficult to fund,“ she says. “They took a risk, and hopefully the Arthritis Foundation can say the investment paid off.“