Group-based quality improvement sessions, based on the recommended “treat to target” (TTT) approach, can help rheumatologists improve the quality of their care for rheumatoid arthritis (RA) patients, a recent study suggests.
Results of the study, “Implementation of Treat to Target in Rheumatoid Arthritis through a Learning Collaborative: Results of the TRACTION Randomized Controlled Trial,” were published in the journal Arthritis & Rheumatology.
TTT is an approach to care that involves setting a treatment target, measuring progress toward achieving the target regularly, altering treatments until reaching and maintaining a target, and increasing co-decision-making with patients.
TTT is an accepted method of managing RA, but some evidence has suggested poor patient adherence.
Researchers tested the effects of a group-based, multi-site learning collaborative to improve adherence to TTT principles. The study included 11 rheumatology sites in the United States and a randomized group of 320 patients whose providers participated in the face-to-face and webinar learning sessions, and a wait-list control group of 321 participants.
The average TTT score was 11 percent at the study’s start in both groups, indicating a low adherence to this care approach.
The TTT score was a composite of four required items documented in the visit notes for each participant at two time points. The four items were:
- Specifying a disease activity target.
- Recording RA disease activity.
- Documenting shared-decision making.
- Deciding treatment based on target and disease activity measures.
Researchers found that nine months after implementing their approach, the intervention group had a TTT score of 57 percent, while the control group scored 25 percent.
“This trial demonstrates the tremendous value of a learning collaborative where teams work together using rapid cycle improvement methods to enhance care,” Daniel Solomon, MD, of the Division of Rheumatology at Brigham and Women’s Hospital and lead author of the study, said in a press release. “We showed that a learning collaborative positively impacts implementation of TTT for rheumatoid arthritis; now, rheumatology should consider how to optimize other aspects of their practice through learning collaboratives.”
