Benefits and Sustainability of a Learning Collaborative for Implementation of Treat-to-Target in Rheumatoid Arthritis: Results of a Cluster-Randomized Controlled Phase II Clinical Trial
Daniel H Solomon, Bing Lu, Zhi Yu, Cassandra Corrigan, Leslie R Harrold, Josef S Smolen, Liana Fraenkel, Jeffrey N Katz, Elena Losina, Daniel H Solomon, Bing Lu, Zhi Yu, Cassandra Corrigan, Leslie R Harrold, Josef S Smolen, Liana Fraenkel, Jeffrey N Katz, Elena Losina
Abstract
Objective: We conducted a 2-phase randomized controlled trial of a learning collaborative to facilitate implementation of treat-to-target (T2T) to manage rheumatoid arthritis (RA). We found substantial improvement in implementation of T2T in phase I. Here, we report on a second 9 months (phase II), where we examined the maintenance of response in phase I and predictors of greater improvement in T2T adherence.
Methods: We recruited patients from 11 rheumatology sites and randomized them to either receive the learning collaborative during phase I or to a wait-list control group that received the learning collaborative intervention during phase II. The outcome was change in T2T implementation score (0-100, where 100 = best) from pre- to postintervention. The T2T implementation score was defined as a percent of components documented in visit notes. Analyses examined the extent to which the phase-I intervention teams sustained improvement in T2T, as well as predictors of T2T improvement.
Results: The analysis included 636 RA patients. At baseline, the mean T2T implementation score was 11% in phase I intervention sites and 13% in phase II sites. After the intervention, T2T implementation score improved to 57% in the phase I intervention sites and to 58% in the phase II sites. Intervention sites from phase I sustained the improvement during the phase II (52%). Predictors of greater T2T improvement included having only rheumatologist providers at the site, academic affiliation of the site, having fewer providers per site, and the rheumatologist provider being a trainee.
Conclusion: Improvement in T2T remained relatively stable over a postintervention period.
Trial registration: ClinicalTrials.gov NCT02260778.
Conflict of interest statement
Potential Conflicts: None of the authors describe conflicts with the manuscript.
© 2018, American College of Rheumatology.
Source: PubMed