Using a Learning Collaborative to Develop an RA Disease Activity Communication Tool to Promote Shared Decision-Making in Treat to Target

Lucy Liu¹, Sonam Choden ², Jennifer Barton ³, Puneet Bajaj ⁴, Christie Bartels ⁵, Maria Danila ⁶, Elizabeth Wahl ⁷, Kimberly Reiter ⁸, Joann Zell ⁹, Christina Downey, MD ¹⁰, Elena Weinstein ¹¹, Gabriela Schmajuk ² and Jinoos Yazdany ¹², ¹UCSF, Oakland, CA, ²UCSF, SFVAMC Division of Rheumatology, San Francisco, CA, ³VA Portland Health Care System & Oregon Health & Science University, Portland, OR, ⁴UT Southwestern, Dallas, ⁵University of Wisconsin School of Medicine and Public Health, Madison, WI, ⁶University of Alabama at Birmingham, Birmingham, AL, ⁷VA Puget Sound, Seattle, WA, ⁸Albuquerque VA Medical Center, University of NM School of Medicine, Albuquerque, NM, ⁹Denver Health, Denver, CO, ¹⁰Loma Linda University Medical Center, Loma LInda, CA, ¹¹University of Colorado Department of Rheumatology, Denver, CO, ¹²UCSF Division of Rheumatology, San Francisco, CA

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: learning collaborative, patient reported outcome and communication tool, shared decisionmaking, treat to target

Session Information

Date: Tuesday, November 12, 2019

Title: 5T111: Measures of Healthcare Quality II: Quality Improvement in Rheumatology – Still Getting Better (2828–2833)

Session Type: ACR Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: A treat to target (T2T) approach in managing RA can improve patient outcomes. A key component to T2T is establishing personalized treatment targets through shared decision-making (SDM) with patients, which can be difficult to implement in practice. We established a learning collaborative to develop a patient communication tool to help promote SDM and T2T in RA.

Methods: The RISE Learning Collaborative (RISE-LC) was established in March 2019 to share and coordinate quality improvement (QI) efforts in adult rheumatology practices across multiple centers. The structure of the RISE-LC is based on the Institute for Healthcare Improvement’s Breakthrough Series[1], where Collaborative faculty and participants work together to improve performance on agreed upon quality measures. Participants completed a survey ranking quality measures of interest, then attended in an in-person meeting with Collaborative faculty to develop goals for RISE-LC, including 1) improving physician-patient communication about disease activity (DA) and patient-reported outcomes (PRO) and 2) formally soliciting patient goals and incorporating them into a personalized treatment target through SDM. We used a human-centered design process to develop components of a DA communication tool, based on a series of patient and physician focus groups. The RISE-LC participants implemented the tool through Plan-Do-Study-Act (PDSA) cycles, and iterative changes were made based on participants’ input.

Results: We recruited a total of 9 sites from 8 states, mostly representing academic centers (7/9). At baseline, all sites had a workflow in place for measuring RA DA, although performance was variable (range 30% to 90%). Participants agreed on a group QI project to solicit patient goals and improve SDM to support T2T. The first iteration of tool development was based on findings from patient focus groups that revealed that patients prefer a graphic display for DA[2]. Participants performed initial PDSA cycles to pilot use of the tool in their practices. Subsequent iterations of the tool incorporated the open-ended question “What’s on your mind today?” (used in one faculty’s [PB’s] health system) and RA-specific questions based on an Arthritis Conversation Tool developed by one faculty expert (JLB) (Fig 1). A second PDSA cycle of the revised tool demonstrated feasibility and patient acceptance (3/9 sites).

Conclusion: The RISE-LC is a continuous, systematic model for sharing in QI efforts across rheumatology clinics. Through broad participant input, human-centered design, and iterative tests of change, an innovative patient communication tool was developed. Future work will examine the impact of the tool on improving documentation of DA, treatment goals, and patient satisfaction and engagement.

[1] The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on www.IHI.org)
[2] Ragouzeos D, Gandrup J, Berrean B, et al. “Am I OK?” using human centered design to empower rheumatoid arthritis patients through patient reported outcomes. Patient Educ Couns. 2019; 102(3):503-510

CDAI_worksheet_B

Figure 1. RA Disease Activity Communication Tool with Patient and Physician Components to Facilitate Goal Setting and Shared Decision Making. The green worksheet to the left is completed by patients prior to their visit, and the reverse-side blue worksheet to the right is completed by the physician during the clinical encounter.

Disclosure: L. Liu, None; S. Choden, None; J. Barton, None; P. Bajaj, None; C. Bartels, Pfizer, 2, Pfizer Independent Grants for Learning and Change, 2; M. Danila, Pfizer, 2, Sanofi Regeneron, 5; E. Wahl, None; K. Reiter, None; J. Zell, None; C. Downey, MD, None; E. Weinstein, None; G. Schmajuk, None; J. Yazdany, Astra Zeneca, 5, Pfizer, 2.

To cite this abstract in AMA style:

Liu L, Choden S, Barton J, Bajaj P, Bartels C, Danila M, Wahl E, Reiter K, Zell J, Downey, MD C, Weinstein E, Schmajuk G, Yazdany J. Using a Learning Collaborative to Develop an RA Disease Activity Communication Tool to Promote Shared Decision-Making in Treat to Target [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/using-a-learning-collaborative-to-develop-an-ra-disease-activity-communication-tool-to-promote-shared-decision-making-in-treat-to-target/. Accessed .

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/using-a-learning-collaborative-to-develop-an-ra-disease-activity-communication-tool-to-promote-shared-decision-making-in-treat-to-target/