Treat‐to‐Target Approach in Rheumatoid Arthritis: A Quality Improvement Trial

• Published in: Arthritis care & research (2010) Vol. 73; no. 2; pp. 207 - 214
• Main Authors: Desai, Sonali P., Leatherwood, Cianna, Forman, Malka, Ko, Eunji, Stevens, Emma, Iversen, Maura, Xu, Chang, Lu, Bing, Solomon, Daniel H.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2021
• Subjects: Aged; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Collaboration; Decision making; Decision Making, Shared; Drug Substitution; Female; Humans; Interdisciplinary Placement; Interrupted Time Series Analysis; Learning; Male; Medicin och hälsovetenskap; Middle Aged; Patient Participation; Patient Reported Outcome Measures; Patients; Physician-Patient Relations; Quality control; Quality Improvement; Quality Indicators, Health Care; Rheumatoid arthritis; Rheumatologists; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 2151-464X; 2151-4658; 2151-4658
• DOI: 10.1002/acr.24114

Objective Using a quality improvement approach, our objective was to integrate a treat‐to‐target approach for rheumatoid arthritis (RA) through routine electronic collection of patient‐reported disease activity scores and a multidisciplinary learning collaborative for rheumatologists. Methods RA patients completed a patient‐reported outcome measure, the Routine Assessment of Patient Index Data 3 (RAPID3), at check‐in. Nine rheumatologists and their patients were allocated to a learning collaborative intervention group focused on a treat‐to‐target approach and 13 were allocated to a control group. The primary outcome was documentation of a treat‐to‐target implementation score: disease activity score, disease activity score used in the medication change decision, the presence of a treatment target, and an indication of shared decision‐making. A primary analysis of patient visits with medication changes was conducted using an interrupted time‐series analysis. Results We studied 554 individual rheumatology patients with 709 patient visits. Treat‐to‐target implementation scores among intervention rheumatologists (mean ± SD 44.6% ± 1.63%) were 12.4% higher than in the control group (mean ± SD 32.2% ± 1.50%; P < 0.0001). We observed differences in treat‐to‐target implementation score components, comparing intervention group to control group rheumatologists: disease activity score present, 77.2% versus 68.0% (P = 0.02); disease activity score used in the medication change decision, 45.2% versus 30.0% (P < 0.01); treatment target, 9.0% versus 0.4% (P < 0.01); and shared decision‐making, 46.9% versus 30.0% (P < 0.01). Secondary analysis of patient visits with high RAPID3 scores found that medication changes were 54% less likely in the intervention versus control group (odds ratio 0.46 [95% confidence interval 0.27–0.79], P = 0.005). Conclusion This nonrandomized, interrupted time‐series trial demonstrated a modest but significant impact of a learning collaborative intervention on rheumatologist documentation of a treat‐to‐target approach in RA.