Pediatric Rheumatology Online Journal → June 2003 → Miscellaneous Topics→ Abstract #80

THE MISSOURI JUVENILE ARTHRITIS PROGRAM (MJAP): 1993 - 2001

J. T. Cassidy.¹

¹Department of Child Health, University of Missouri, Columbia, MO, United States

The MJAP was initiated and funded in 1993 - 1994 by the Bureau of Special Health Care Needs of the State of Missouri to focus on two objectives: 1. To improve the care of children with rheumatic diseases by case coordination extending from the medical centers to home communities and schools; and 2. To increase the number of children referred to pediatric rheumatology clinics for diagnosis and long-term care. The present study was initiated to examine the extent of attainment of these goals starting in 1993.
Methods: Children with a diagnosis of juvenile oligoarticular arthritis (JOA) by the 1986 American College of Rheumatology Criteria seen in our clinics from 1993 - 2001 were reviewed as a proxy for a clinic-specific prevalence rate. These rates were compared to a conservative estimate of prevalence for the central area of the state adjusted for age at onset, sex, and type of onset.
Results: 154 children with JOA who had attended our clinics from 1991 - 2001 were identified. Only one visit (new patient or return visit) per child per year was counted. During this period 44 children were lost to follow-up; a sustained remission occurred in 33; 11 reached an age of 21 years and were no longer followed; and 24 were seen only once. The average attendance per year for 1991 - 1993 before implementation of case coordination was 51 (range 38 - 51) and for 1994 - 2001 after implementation, was 47 (range 34 - 57).
Conclusions: Our clinic-specific prevalence data do not confirm that this state-wide program has altered the referral and retention rates for children with JOA in the central area of Missouri. They are also less than one-third of the expected prevalence for JOA. However, clinical analysis of the long-term follow-up of these children indicates that state-funded coordination of care improved access to community services, and compliance with the therapeutic program, and satisfaction among parents and health care professionals evident in improved communication and coordination of services.