التفاصيل البيبلوغرافية
| العنوان: |
Implementation of Treat-to-Target in Rheumatoid Arthritis Through a Learning Collaborative: Results of a Randomized Controlled Trial. |
| المؤلفون: |
Solomon, Daniel H., Losina, Elena, Lu, Bing, Zak, Agnes, Corrigan, Cassandra, Lee, Sara B., Agosti, Jenifer, Bitton, Asaf, Harrold, Leslie R., Pincus, Theodore, Radner, Helga, Yu, Zhi, Smolen, Josef S., Fraenkel, Liana, Katz, Jeffrey N. |
| المصدر: |
Arthritis & Rheumatology; Jul2017, Vol. 69 Issue 7, p1374-1380, 7p |
| مصطلحات موضوعية: |
CLINICAL trials, INTERPROFESSIONAL relations, LEARNING strategies, MEDICAL cooperation, PROBABILITY theory, PROFESSIONAL employee training, QUALITY assurance, REGRESSION analysis, RESEARCH, RHEUMATOID arthritis, STATISTICAL sampling, RANDOMIZED controlled trials, DESCRIPTIVE statistics |
| مصطلحات جغرافية: |
UNITED States |
| مستخلص: |
Objective Treat-to-target (TTT) is an accepted paradigm for the management of rheumatoid arthritis (RA), but some evidence suggests poor adherence. The purpose of this study was to test the effects of a group-based multisite improvement learning collaborative on adherence to TTT. Methods We conducted a cluster-randomized quality-improvement trial with waitlist control across 11 rheumatology sites in the US. The intervention entailed a 9-month group-based learning collaborative that incorporated rapid-cycle improvement methods. A composite TTT implementation score was calculated as the percentage of 4 required items documented in the visit notes for each patient at 2 time points, as evaluated by trained staff. The mean change in the implementation score for TTT across all patients for the intervention sites was compared with that for the control sites after accounting for intracluster correlation using linear mixed models. Results Five sites with a total of 23 participating rheumatology providers were randomized to intervention and 6 sites with 23 participating rheumatology providers were randomized to the waitlist control. The intervention included 320 patients, and the control included 321 patients. At baseline, the mean TTT implementation score was 11% in both arms; after the 9-month intervention, the mean TTT implementation score was 57% in the intervention group and 25% in the control group (change in score of 46% for intervention and 14% for control; P = 0.004). We did not observe excessive use of resources or excessive occurrence of adverse events in the intervention arm. Conclusion A learning collaborative resulted in substantial improvements in adherence to TTT for the management of RA. This study supports the use of an educational collaborative to improve quality. [ABSTRACT FROM AUTHOR] |
|
Copyright of Arthritis & Rheumatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
Full Text Finder