{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T09:10:29Z","timestamp":1790327429915,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000936","name":"Gordon and Betty Moore Foundation","doi-asserted-by":"publisher","award":["GRT 00004483"],"award-info":[{"award-number":["GRT 00004483"]}],"id":[{"id":"10.13039\/100000936","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["K08\u2010HS028682"],"award-info":[{"award-number":["K08\u2010HS028682"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017759","name":"Childhood Arthritis and Rheumatology Research Alliance","doi-asserted-by":"publisher","award":["GRT 00004219"],"award-info":[{"award-number":["GRT 00004219"]}],"id":[{"id":"10.13039\/100017759","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["K24\u2010AR078950"],"award-info":[{"award-number":["K24\u2010AR078950"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005320","name":"AcademyHealth","doi-asserted-by":"publisher","award":["GRT 00004483"],"award-info":[{"award-number":["GRT 00004483"]}],"id":[{"id":"10.13039\/100005320","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000980","name":"Arthritis Foundation","doi-asserted-by":"publisher","award":["GRT 00004219"],"award-info":[{"award-number":["GRT 00004219"]}],"id":[{"id":"10.13039\/100000980","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although early diagnosis improves long\u2010term outcomes, patients with juvenile idiopathic arthritis (JIA) often experience prolonged, circuitous paths to diagnosis. To inform diagnostic improvement, we sought to characterize health care utilization in the year preceding diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified 10,021 patients with an incident diagnosis of JIA and 20,042 age\u2010 and sex\u2010matched healthy controls in the Merative MarketScan administrative datasets (2014\u20132022). Using negative binomial or hurdle models, we calculated incidence rate ratios (IRRs) comparing outpatient, inpatient, and emergency department or urgent care (ED\/UC) utilization between patients with JIA and controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the year before diagnosis, patients with JIA had significantly increased health care utilization compared to controls (IRR 2.55 [95% confidence interval (CI) 2.49\u20132.62],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Accounting for sex, age, and insurance, utilization was increased across care settings: outpatient (IRR 2.56 [95% CI 2.49\u20132.62],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), inpatient (IRR 2.00 [95% CI 1.48\u20132.71],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), and ED\/UC encounters (IRR 1.76 [95% CI 1.67\u20131.86],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The most common visits by patients with JIA preceding diagnosis were to a general practitioner (91.8%), ED\/UC (47.0%), and orthopedist (22.9%). Health care utilization increased as the index date approached. In patients insured by Medicaid, ED\/UC care was more frequent (odds ratio 2.05 [95% CI 1.89\u20132.23]) and orthopedic care less frequent (odds ratio 0.27 [95% CI 0.24\u20130.34]) than in patients with commercial insurance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the year before diagnosis, children with JIA have significantly higher health care utilization compared to healthy peers. There are differences in the patterns of utilization in patients with Medicaid versus commercial insurance. There may be opportunities for earlier identification of JIA in primary care, orthopedics, and ED\/UC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.80037","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T14:34:45Z","timestamp":1773066885000},"page":"1544-1551","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High Health Care Utilization Preceding Diagnosis With Juvenile Idiopathic Arthritis"],"prefix":"10.1002","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4247-5226","authenticated-orcid":false,"given":"Anna","family":"Costello","sequence":"first","affiliation":[{"name":"The Children's Hospital of Philadelphia  Philadelphia Pennsylvania"},{"name":"The Perelman School of Medicine at the University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Xiao","sequence":"additional","affiliation":[{"name":"The Perelman School of Medicine at the University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemei","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Perelman School of Medicine at the University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jahan","family":"Jazayeri","sequence":"additional","affiliation":[{"name":"The Children's Hospital of Philadelphia  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irit R.","family":"Rasooly","sequence":"additional","affiliation":[{"name":"The Children's Hospital of Philadelphia  Philadelphia Pennsylvania"},{"name":"The Perelman School of Medicine at the University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9724-0443","authenticated-orcid":false,"given":"Pamela F.","family":"Weiss","sequence":"additional","affiliation":[{"name":"The Children's Hospital of Philadelphia  Philadelphia Pennsylvania"},{"name":"The Perelman School of Medicine at the University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Textbook of pediatric rheumatology","author":"Petty RE","year":"2020"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25482"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.43401"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kead032"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.131503"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.34343"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23709"},{"issue":"9","key":"e_1_2_7_9_1","article-title":"Delayed diagnosis and accrual of joint damage in incident cases of juvenile idiopathic arthritis [abstract]","volume":"76","author":"Costello A","year":"2024","journal-title":"Arthritis Rheumatol"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.100083"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12969-020-0413-7"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes004"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12969-023-00809-8"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/children11050600"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22466"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew021"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22882"},{"key":"e_1_2_7_18_1","article-title":"MarketScan research databases for life sciences researchers","author":"Merative","year":"2023","journal-title":"Merative"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.180168"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24100"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.34348"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.55563\/clinexprheumatol\/3bu1sf"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/2475530318799072"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.20579"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-14-199"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40488-021-00121-4"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa438"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25438"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12969-021-00531-3"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2024-327426"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23485"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.01.022"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-021-02628-2"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-022-06100-7"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24497"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2023-063678R"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2016.0075"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/0046958019838118"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1013285"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.10.022"}],"container-title":["Arthritis Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.80037","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acr.80037","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.80037","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:38:10Z","timestamp":1790325490000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.80037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":39,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/acr.80037"],"URL":"https:\/\/doi.org\/10.1002\/acr.80037","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]},"assertion":[{"value":"2025-11-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}