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, 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. 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.
 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)
 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
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 December 2, 2020.
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