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REAL-TIME PATIENT INPUT ON TREATMENT SATISFACTION ENHANCES TREAT-TO-TARGET RA MANAGEMENT
Newswise — CHICAGO – Patient-reported outcomes and input about treatment satisfaction collected via tablet computers in the clinic can enhance a treat-to-target approach for managing rheumatoid arthritis, according to new research findings presented this week at the 2018 ACR/ARHP Annual Meeting (Abstract #326).
Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. It is a chronic disease that causes joint pain, stiffness, swelling and decreased movement of the joints. Small joints in the hands and feet are most commonly affected. Sometimes RA can affect your organs, such as eyes, skin or lungs. About 75 percent of RA patients are women.
Rheumatology professionals often find it challenging to incorporate patient-reported outcome measures for disease-activity assessment into routine workflow. At Brigham and Women’s Hospital and Harvard Medical School’s rheumatology clinic in Boston, staff integrated in their practice a treat-to-target approach for medication optimization for RA patients. This approach collects disease activity scores via iPad tablets in the waiting room. They conducted a non-randomized, quality improvement study to assess the success of their program implementations.
“The main goal of our study was to reduce the burden of rheumatoid arthritis among our patients by implementing a treat-to-target strategy, which has been shown to improve disease control in small, randomized clinical trials,” said Cianna Leatherwood, MD, a rheumatologist now at Kaiser Permanente Oakland Medical Center and the study’s co-author. “Treat-to-target emphasizes the importance of routinely using a disease assessment tool to evaluate disease activity and to assist in making clinical decisions. We chose to use the Routine Assessment of Patient Index Data 3 (RAPID3) because it could be consistently implemented in our clinic. We wanted to use a tool that did not generate excess work for our providers and one that could be completed entirely by patients.”
Using either a tablet or online patient portal, 2,549 RA patients in the study completed a RAPID3 survey, from May 2017 to May 2018. RAPID3 scores were uploaded to patient electronic medical record charts in real-time, and they were available for their physicians to review during the office visit. Rheumatologists in the study were non-randomly allocated to either intervention (nine rheumatologists) or control (13 rheumatologists) groups. Intervention physicians attended monthly learning collaborative sessions between August 2017 and September 2018 in order to discuss and develop treat-to-target practices to use during RA patients’ office visits. They also reviewed their own data on treat-to-target documentation, and received email reminders about adoption of a treat-to-target approach.
Two researchers retrospectively examined physician visit notes to identify patients with medication changes and to calculate documentation of a treat-to-target score. Mean treat-to-target scores between the intervention and control rheumatologists were evaluated using T-test. Clinic staff also called the patients of intervention group rheumatologists following their medication changes to measure their treatment satisfaction using the Treatment Satisfaction Questionnaire for Medication (TSQM), and shared decision making through the nine-item Shared Decision Making Questionnaire (SDM-Q-9). Both questionnaires are on 100-point scales with higher numbers reflecting positive scores.
In preliminary data, mean treat-to-target scores among the intervention group were 15 percent higher than controls. Of 104 completed phone calls to RA patients in the intervention group, there were median TSQM scores of 73 for effectiveness, 85 for side effects, 89 for convenience, and 77 for global satisfaction. There was a median SDM-Q-9 score of 91 for the patients of the intervention group physicians. Based on this, the researchers concluded that electronic patient-reported outcome measure collection methods and real-time integration of survey scores in patients’ electronic medical records is a useful way to enhance treat-to-target management of patients with RA.
“One of the strongest characteristics of our study is that it is based on a real-life clinic model, and reflects our experience in an everyday setting,” said Dr. Leatherwood. “We hope that our experience can exemplify that it is possible to pursue routine implementation of patient-reported outcome measures into daily clinical practice. We were able to achieve buy-in at all levels of our clinic staff, including the front desk personnel, medical assistants and clinic management. This was an essential part of incorporating the surveys into routine workflow. Additionally, we learned from initial patient focus groups that shared decision-making was an important facet of RA management and medication adherence.”
About the ACR/ARHP Annual Meeting
The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. With more than 450 sessions and thousands of abstracts, if offers a superior combination of basic science, clinical science, tech-med courses, career enhancement education and interactive discussions on improving patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official #ACR18 hashtag.
About the American College of Rheumatology
The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.
Abstract #: 326
Implementation of a Treat-to-Target Quality Improvement Program for Rheumatoid Arthritis Management Using Real-Time Patient Reported Outcome Measures
Malka Forman1, Cianna Leatherwood1, Chang Xu1, Eunji Ko1, Bing Lu2, Maura D. Iversen3, Daniel Solomon1 and Sonali Desai1, 1Brigham and Women's Hospital, Boston, MA, 2Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 3Brigham and Women's Hospital and Harvard Medical School, Boston, MA
Background/Purpose: Changing clinical practice patterns and incorporation patient-reported outcome measures (PROMs) for disease activity assessment into routine workflow is challenging. We sought to integrate a treat-to-target (TTT) approach for medication optimization for patients with RA in our practice through: 1) a reliable system to collect disease activity scores (PROMs) using iPads in the waiting room, 2) a multidisciplinary learning collaborative (LC) for providers focused on TTT, and 3) incorporation of patient perspectives on shared decision making (SDM) and treatment satisfaction.
Methods: At an academic medical center rheumatology clinic, patients completed a Routine Assessment of Patient Index Data 3 (RAPID3) survey via an online patient portal or an iPad. RAPID3 scores were uploaded to patient charts and were available for physicians to review during the visit. Rheumatologists were non-randomly allocated to either intervention (N=8) or control (N=13) groups. Intervention physicians attended monthly LC sessions between August 2017-June 2018 to discuss and develop TTT practices to use during visits with RA patients. Physician visit notes were retrospectively examined by 2 researchers to identify patients with medication changes and to calculate a “TTT score”. Mean TTT scores between intervention and control rheumatologists were evaluated using T-test. Phone calls were made to patients of physicians in the intervention group following a medication change to measure treatment satisfaction using the Treatment Satisfaction Questionnaire for Medication (TSQM) and use of SDM through the 9-item Shared Decision Making Questionnaire (SDM-Q-9). The TSQM and SDM-Q-9 questionnaires are both on 100 point scales and higher numbers reflect positive scores.
Results: From May 2017-April 2018, 2656 RA patients completed RAPID3 surveys with an average completion rate of 70%. Mean TTT scores among the intervention group rheumatologists were 9% higher than those in the control group (43% vs. 34%, p= 0.0042) (Figure). 72 phone calls were completed to patients of rheumatologists in the intervention group with median[IQR] TSQM score components of 75[58, 92] (effectiveness), 92[83, 100] (side effects), 100[89, 100] (convenience), and 83 [67, 100] (global satisfaction), and median[IQR] SDM-Q-9 score of 96[87, 00].
Conclusion: The results of this non-randomized, quality improvement study show feasibility and utility of electronic PROMs collection methods and real-time integration of PROMs survey scores into the electronic medical record. It also demonstrates the ability of a learning collaborative model to impact TTT practices within a large academic medical practice, as the non-randomized fashion mimics “real-world” experience.
Disclosures: M. Forman, None. C. Leatherwood, None. C. Xu, None. E. Ko, None. B. Lu, None. M. D. Iversen, None. D. Solomon, None. S. Desai, None.
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