Background/Purpose: In many patients with rheumatoid arthritis (RA), the disease is not adequately controlled, and only a minority of patients attain the goal of consistent remission or low disease activity. A study was conducted to determine if online, simulation-based educational interventions could improve clinical decisions made by rheumatologists regarding the management of patients with RA, including first-line and second-line biologic therapies.

Methods: A cohort of practicing rheumatologists from several countries who participated in online, simulation-based education was evaluated. The simulation consisted of two cases presented in a platform that allowed physician learners to choose from numerous lab tests and assessment scales as well as thousands of diagnoses, treatments, and procedures matching the scope and depth of actual practice. The clinical decisions made by the participants were analyzed using an artificial intelligence engine, and instantaneous clinical guidance was provided employing current evidence-based and expert faculty recommendations. Participant decisions were collected after clinical guidance and compared with each user’s baseline data using a 2-tailed paired T-test (P<0.05 was considered statistically significant) to assess the impact of simulation-based education on the clinical decisions made by participants. Data is reflective of learners who participated in the assessment from 10/29/14 to 4/29/15.

Results:

The assessment sample consisted of 282 rheumatologists who made clinical decisions within the simulation and proceeded to the concluding, debrief section within the study period. As a result of clinical guidance (CG), significant improvements were observed in several areas of management in patients with RA (post-CG vs pre-CG) specifically:

• 33% improvement in the identification of RA flare in a patient who had stopped MTX due to intolerance (P<.0001)

• 34% improvement in selection of non-TNF biologic agent upon inadequate response to traditional DMARDs (P<.0001). Most of this improvement resulted from increase in tocilizumab monotherapy selection.

• 13% more participants correctly decided to discontinue adalimumab (baseline, P<.02)
• 28% increase in the decision to prescribe non-TNF biologic in an adalimumab non-responder (P<.0001). Most increase came from selection of tocilizumab, followed by abatacept, and rituximab.

Conclusion: This study demonstrated the success of online, simulation-based education on improving the evidence-based clinical decisions by rheumatologists in selecting appropriate treatment for first-line biologic and switching to second-line biologic agents. Simulation-based instructions that lead to improvement in physician performance in a consequence-free environment can result in more evidence-based clinical decisions for RA and improvement in patient outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-clinical-decisions-for-rheumatoid-arthritis-management-using-online-medical-simulations/