Measurable Outcomes of an Ophthalmology and Rheumatology Coordinated Care Clinic.

Abstract

Evaluate the impact of an Ophthalmology/Rheumatology multidisciplinary clinic for patients with anterior uveitis by comparing outcomes between those who received traditional care (TC) versus coordinated care (CC). We conducted a retrospective cohort study of children with anterior uveitis from a pediatric tertiary care center between 2013 and 2022. Standard descriptive statistics were used; survival analyses explored differences in cohort disease activity and biologic DMARDs use. Steroid use by cohort was compared using generalized estimating equation model with Poisson distribution and log link. Complications were compared using logistic regression. Number of visits in each cohort were assessed using Poisson generalized estimating equation model adjusted for complications. We studied 215 anterior uveitis patients: 66% were female, 53% had JIA, 23% were idiopathic, with a median age at diagnosis of eight (interquartile range (IQR) 5-12). CC was associated with a 60% higher hazard (HR = 1.6; p < 0.01) of reaching disease control, when controlling for time since diagnosis and anterior chamber cell counts at beginning of disease activity. CC was associated with starting biologic DMARDs faster than TC (p < 0.01). Compared to TC, CC had a 96% lower rate of corticosteroid use per appointment within the first year (p< 0.01). The visit rate was 64% lower for CC, when controlling for total complications per patient. Patients who received multidisciplinary care had better outcomes than patients who received traditional care. Limitations include different cohort-start times and absence of defined criteria for coordinated care referral.