Leveraging the PEDSnet Clinical Research Network and Electronic Health Record Data to Enhance Efficiency of Trial Enrollment for a Rare Pediatric Rheumatic Disease

Abstract

**Background:**<br> We evaluated the PEDSnet clinical research network for study enrollment of juvenile spondyloarthritis, a rare rheumatic disease that includes enthesitis-related arthritis (ERA) and psoriatic arthritis (PsA).

**Methods:**<br> An electronic health record (EHR)-based typology was developed by an interdisciplinary team to query EHR data for a spectrum of pediatric rheumatic diseases (2009–2023) from 8 PEDSnet centers. The prevalence, characteristics and drug exposures for juvenile spondyloarthritis was explored to gauge feasibility of leveraging the network for study enrollment. Next, the typology was adapted to identify subjects for a clinical trial; the efficiency of EHR typology query was compared to standard screening efforts.

**Results:**<br> Code sets for 35 pediatric rheumatology conditions were developed to identify potentially eligible subjects in the PEDSnet network. 2510 unique patients with juvenile spondyloarthritis across the PEDSnet health care systems over the years of study were identified. Median age at 1st rheumatology visit was 12.9 years, 50.4% were female, and the median time from 1st to last rheumatology visit was 4.2 years. The spondyloarthritis typology was adapted to screen for eligible patients for the BACK-OFF JSpA trial. Over 3-months at one institution, the query saved 19.5 h and 1.9 h of effort compared to manual screening of all juvenile arthritis or enthesitis-related arthritis patient charts, respectively.

**Conclusions:**<br> Results support the capacity of the PEDSnet clinical research network to facilitate identification of subjects for rare pediatric rheumatic disease studies. Typologies for these diseases were developed and can be leveraged for clinical trial recruitment to improve efficiency.