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. Underlying clinical practice gaps and educational needs were identified and a study was conducted to determine if an online educational intervention specifically designed to address the identified practice gaps could improve knowledge and competence of rheumatologists with respect to evidence-based management of patients with RA.

Methods: A cohort of practicing rheumatologists participated in an innovative educational intervention that used a problem-based learning model and short-branching technology. Clinical decision questions included at 3 critical points in each of the 2 case vignettes provided tailored feedback and clinical consequences related to the specific answer selected. Learners who did not make the correct decision on the first attempt were allowed a second opportunity to make a decision. Each case also included knowledge assessment questions pre- and post-intervention. The education launched on August 31 2012 and data were collected through November 13, 2012 (76 days). A paired 2-tailed t-test was used to assess differences in mean scores between knowledge assessment questions pre- and post-education. Pearson’s χ2 statistic was used to measure changes in responses to individual questions. For the consequence-based clinical decision questions a test of proportions was used to determine the effectiveness of the feedback provided for incorrect first attempts. P value of less than .05 indicates statistical significance.

Results:

A total of 456 rheumatologists participated in the activity during the data collection period and 146 (who answered all questions) were included in the analysis. Evaluation of the knowledge assessment questions demonstrated statistically significant improvements (n = 146; P < .05), with an overall large effect size of 0.829. Improvements post-guidance in specific clinical decisions were as follows:

• 52% improvement post education in determination of the level of RA disease activity objectively using a predefined metric (P = .01)
• In a patient who developed new or worsening symptoms consistent with heart failure while receiving treatment with anti-TNF agents, 38% more rheumatologists recommended evaluation with transthoracic echocardiogram post education (P = .01)
• Post education, 62% more rheumatologists correctly identified Clinical Disease Activity Index as the validated metric that incorporates both patient- and clinician-derived data (P = .001)
• 76% improvement in switching to correct biologic therapy for a patient with RA who developed CHF while receiving treatment with an anti-TNF agent and had to discontinue methotrexate due to adverse effects (P = .07)

Conclusion: Statistically significant improvement in knowledge and competency of rheumatologists who completed the educational intervention was demonstrated in a number of areas. Technology-enhanced educational interventions utilizing consequence-based feedback can significantly impact rheumatology practices in the management of patients with RA.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/success-of-educational-intervention-in-improving-the-management-of-rheumatoid-arthritis/