Virtual approach improves treat-to-target implementation in rheumatoid arthritis
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Virtual learning collaboratives, which are less intensive and relatively low-cost compared with in-person models, can improve treat-to-target implementation for rheumatoid arthritis, according to data published in Arthritis Care & Research.
“While the data supporting [treat to target (TTT)] are strong and the recommendations are clear, this algorithm for managing RA is not routinely implemented in clinical care,” Daniel H. Solomon MD, MPH, of Brigham and Women’s Hospital, in Boston, and colleagues wrote. “In prior studies, we documented that implementation of TTT could be improved through a learning collaborative (LC).”
“An LC is a systematic approach to process improvement, whereby organizations test and implement changes and measure the impact of these changes; simultaneously, different organizations share their experiences to accelerate learning,” they added. “We used such a method to improve adherence to TTT for RA in the TRACTION Trial which recruited 11 U.S. rheumatology practices to participate in an LC. The LC included a face-to-face kick-off meeting and 9 monthly webinars. Since the LC intervention was effective and the benefits were sustained, we considered whether a less intensive LC might be as effective.”
To assess the feasibility and effectiveness of a shorter learning collaborative in improving TTT implementation, Solomon and colleagues initially planned to conduct a study lasting 6 months in 2020. However, when the COVID-19 pandemic struck the United States and limited travel nationwide, it added yet another aspect to the study: the abbreviated learning collaborative would also be 100% virtual.
“Because the learning collaborative ran during COVID, we had the opportunity to compare adherence with TTT during face-to-face RA visits compared with virtual patient visits,” Solomon told Healio Rheumatology.
A total of 18 U.S. rheumatology practices, including 45 clinicians, participated in the 6-month, fully virtual learning collaborative in ambulatory care. All meetings used video conferencing, with data sharing performed via a website. The collaborative included a 6-hour “kick-off” session and six monthly webinars, in which participants discussed TTT in RA, its rationale and rapid cycle improvement as a means for its implementation. Practices provided anonymous patient visit data. TTT adherence data were measured as the percentage of completed TTT processes.
In all, the participating sites contributed data on 1,826 patient visits, of which 78% were in-person and 22% were virtual. The researchers compared TTT adherence between in-person and virtual visits.
According to the researchers, TTT adherence improved from a mean of 51% at baseline to 84% at 6 months (P <.001), with each aspect of TTT also improving. Adherence to TTT during virtual visits was lower, at 65%, than with in-person visits, at 79% (P < .0001).
“The 6-month virtual collaborative produced significant improvements in TTT implementation, increasing adherence from 50% to 75% over 6 months,” Solomon said. “Adherence with TTT started much lower than during face-to-face visits, but after the learning collaborative, rates were nearly identical. This suggests that with the efforts of a learning collaborative, rheumatology practice can adapt to virtual visits for many patients with RA.
“Relatively brief — 6-month — virtual learning collaboratives should be considered for other clinical areas in rheumatology,” he added. “Participants suggested that glucocorticoid-induced osteoporosis management, cardiovascular risk factor treatment and vaccine adherence would be good areas for future learning collaboratives. We hope that state and national rheumatology societies might consider running learning collaboratives on these topics.”
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