المؤلفون: Solomon, Daniel H., Lee, Sara B., Zak, Agnes, Corrigan, Cassandra, Agosti, Jenifer, Bitton, Asaf, Harrold, Leslie R., Losina, Elena, Lu, Bing, Pincus, Ted, Radner, Helga, Smolen, Josef S., Katz, Jeffrey N., Fraenkel, Liana

المساهمون: Department of Orthopaedics and Physical Rehabilitation

المصدر: Seminars in arthritis and rheumatism ; 46 ; 1 ; 81-7

مصطلحات موضوعية: Learning collaborative, Quality improvement, Randomized controlled trial, Rheumatoid arthritis, Treat to target, Musculoskeletal Diseases, Rheumatology

الوصف: BACKGROUND/PURPOSE: Treat-to-target (TTT) is a recommended strategy in the management of rheumatoid arthritis (RA), but various data sources suggest that its uptake in routine care in the US is suboptimal. Herein, we describe the design of a randomized controlled trial of a Learning Collaborative to facilitate implementation of TTT. METHODS: We recruited 11 rheumatology sites from across the US and randomized them into the following two groups: one received the Learning Collaborative intervention in Phase 1 (month 1-9) and the second formed a wait-list control group to receive the intervention in Phase 2 (months 10-18). The Learning Collaborative intervention was designed using the Model for Improvement, consisting of a Change Package with corresponding principles and action phases. Phase 1 intervention practices had nine learning sessions, collaborated using a web-based tool, and shared results of plan-do-study-act cycles and monthly improvement metrics collected at each practice. The wait-list control group sites had no intervention during Phase 1. The primary trial outcome is the implementation of TTT as measured by chart review, comparing the differences from baseline to end of Phase 1, between intervention and control sites. RESULTS: All intervention sites remained engaged in the Learning Collaborative throughout Phase 1, with a total of 38 providers participating. The primary trial outcome measures are currently being collected by the study team through medical record review. CONCLUSIONS: If the Learning Collaborative is an effective means for improving implementation of TTT, this strategy could serve as a way of implementing disseminating TTT more widely.

العلاقة: Link to Article in PubMed; http://dx.doi.org/10.1016/j.semarthrit.2016.02.009Test; Semin Arthritis Rheum. 2016 Aug;46(1):81-7. doi:10.1016/j.semarthrit.2016.02.009. Epub 2016 Mar 8. Link to article on publisher's site; 0049-0172 (Linking); http://hdl.handle.net/20.500.14038/28791Test; https://escholarship.umassmed.edu/faculty_pubs/1030Test; 9072017; faculty_pubs/1030

الإتاحة: https://doi.org/10.1016/j.semarthrit.2016.02.009Test
https://doi.org/20.500.14038/28791Test
https://hdl.handle.net/20.500.14038/28791Test
https://escholarship.umassmed.edu/faculty_pubs/1030Test

المؤلفون: Elman, Scott A, Dong, Yan, Stenquist, Derek S, Ghazinouri, Roya, Alcantara, Luis, Collins, Jamie E, Beagan, Carolyn, Thornhill, Thomas S, Katz, Jeffrey N

مصطلحات موضوعية: Knee arthroplasty, Hip arthroplasty, Osteoarthritis, Rheumatoid arthritis, Global health, Dominican Republic

الوصف: Background To address both the growing burden of joint disease and the gaps in medical access in developing nations, medical relief organizations have begun to launch programs to perform total joint replacement (TJR) on resident populations in developing countries. One outcome of TJR of particular interest is physical activity (PA) since it is strongly linked to general health. This study evaluates the amount of postoperative participation in PA in low-income patients who received total joint replacement in the Dominican Republic and identifies preoperative predictors of postoperative PA level. Methods We used the Yale Physical Activity Survey (YPAS) to assess participation in postoperative PA 1–4 years following total knee or hip replacement. We compared the amount of aerobic PA reported by postoperative TJR patients with the levels of PA recommended by the CDC and WHO. We also analyzed preoperative determinants of postoperative participation in aerobic PA in bivariate and multivariate analyses. Results 64 patients out of 170 eligible subjects (52/128 TKR and 14/42 THR) who received TJR between 2009–2012 returned for an annual follow-up visit in 2013, with a mean treatment-to-follow-up time of 2.1 years. 43.3% of respondents met CDC/WHO criteria for sufficient participation in aerobic PA. Multivariate analyses including data from 56 individuals identified that patients who were both younger than 65 and at least two years postoperative had an adjusted mean activity dimensions summary index (ADSI) 22.9 points higher than patients who were 65 or older and one year postoperative. Patients who lived with friends or family had adjusted mean ADSI 17.2 points higher than patients living alone. Patients who had the most optimistic preoperative expectations of outcome had adjusted mean ADSI scores that were 19.8 points higher than those who were less optimistic. Conclusion The TJR patients in the Dominican cohort participate in less PA than recommended by the CDC/WHO. Additionally, several associations were ...

العلاقة: http://www.biomedcentral.com/1471-2474/15/207Test

الإتاحة: http://www.biomedcentral.com/1471-2474/15/207Test

المؤلفون: Solomon, Daniel H., Pincus, Theodore, Shadick, Nancy A., Stratton, Jacklyn, Ellrodt, Jack, Santacroce, Leah, Katz, Jeffrey N., Smolen, Josef S.

المصدر: Arthritis Care & Research; Apr2022, Vol. 74 Issue 4, p572-578, 7p

مصطلحات موضوعية: RHEUMATOID arthritis, COVID-19 pandemic, COLLABORATIVE learning, VIDEOCONFERENCING, RHEUMATOLOGY

مستخلص: Objective: A treat‐to‐target (TTT) approach improves outcomes in rheumatoid arthritis (RA). In prior work, we found that a learning collaborative (LC) program improved implementation of TTT. We conducted a shorter virtual LC to assess the feasibility and effectiveness of this model for quality improvement and to assess TTT during virtual visits. Methods: We tested a 6‐month virtual LC in ambulatory care. The LC was conducted during the 2020–2021 COVID‐19 pandemic when many patient visits were conducted virtually. All LC meetings used videoconferencing and a website to share data. The LC comprised a 6‐hour kickoff session and 6 monthly webinars. The LC discussed TTT in RA, its rationale, and rapid cycle improvement as a method for implementing TTT. Practices provided de‐identified patient visit data. Monthly webinars reinforced topics and demonstrated data on TTT adherence. This was measured as the percentage of TTT processes completed. We compared TTT adherence between in‐person visits versus virtual visits. Results: Eighteen sites participated in the LC, representing 45 rheumatology clinicians. Sites inputted data on 1,826 patient visits, 78% of which were conducted in‐person and 22% of which were held in a virtual setting. Adherence with TTT improved from a mean of 51% at baseline to 84% at month 6 (P for trend < 0.001). Each aspect of TTT also improved. Adherence with TTT during virtual visits was lower (65%) than during in‐person visits (79%) (P < 0.0001). Conclusion: Implementation of TTT for RA can be improved through a relatively low‐cost virtual LC. This improvement in TTT implementation was observed despite the COVID‐19 pandemic, but we did observe differences in TTT adherence between in‐person visits and virtual visits. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research 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.)

المؤلفون: Solomon, Daniel H., Ayanian, John Z., Yelin, Ed, Shaykevich, Tamara, Brookhart, M. Alan, Katz, Jeffrey N.

المصدر: Arthritis Care & Research, 64(2)

مصطلحات موضوعية: Chronique, Rheumatology, Care, Traitement, Rhumatisme inflammatoire, Inflammatory joint disease, Epidemiology, Ambulatory, Ambulatoire, Pathologie du système ostéoarticulaire, Polyarthrite rhumatoïde, Rheumatoid arthritis, Epidémiologie, Survey, Race, Soin, Immunopathology, Diseases of the osteoarticular system, Rhumatologie, Enquête, Immunopathologie, Maladie autoimmune, Treatment, Chronic, Crónico, Autoimmune disease

الوصف: Disease-modifying anti-rheumatic drugs (DMARDs) are recommended for virtually all patients with rheumatoid arthritis (RA). We investigated the use of DMARDs in patients with RA in a nationally representative sample of visits to US physicians in the National Ambulatory Care Medical Survey (NAMCS).

العلاقة: https://doi.org/10.17615/xwrm-8063Test; https://cdr.lib.unc.edu/downloads/3n2044535?file=thumbnailTest; https://cdr.lib.unc.edu/downloads/3n2044535Test

الإتاحة: https://doi.org/10.17615/xwrm-8063Test
https://cdr.lib.unc.edu/downloads/3n2044535?file=thumbnailTest
https://cdr.lib.unc.edu/downloads/3n2044535Test

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.)

المؤلفون: Kim, Seoyoung C., Schneeweiss, Sebastian, Liu, Jun, Karlson, Elizabeth W., Katz, Jeffrey N., Feldman, Sarah, Solomon, Daniel H.

المصدر: Arthritis & Rheumatology; Sep2016, Vol. 68 Issue 9, p2106-2113, 8p

مصطلحات موضوعية: CERVIX uteri diseases, DYSPLASIA, CERVICAL intraepithelial neoplasia, ALGORITHMS, ANTIRHEUMATIC agents, BIOLOGICAL products, CONFIDENCE intervals, LONGITUDINAL method, MEDICAID, RESEARCH funding, RHEUMATOID arthritis, LOGISTIC regression analysis, PROPORTIONAL hazards models, DATA analysis software, DISEASE risk factors

مستخلص: Objective Recent research showed an increased risk of high-grade cervical dysplasia and cervical cancer associated with rheumatoid arthritis (RA). The purpose of this study was to examine whether this risk was associated with the use of biologic versus nonbiologic disease-modifying antirheumatic drugs (DMARDs). Methods We identified RA patients in the US Medicaid and commercial insurance databases (for the years 2000-2012) who were starting treatment with either a biologic or a nonbiologic DMARD. High-grade cervical dysplasia or cervical cancer was identified with a validated claims-based algorithm, and we assessed utilization of gynecologic procedures. To control for potential confounders, those starting therapy with a biologic DMARD were matched 1:1 to those starting therapy with a nonbiologic DMARD according to the propensity score (PS). Hazard ratios (HRs) and rate ratios (RRs) in the PS-matched Medicaid and commercial insurance cohorts were pooled by an inverse variance-weighted fixed-effects model. Results We included 14,729 pairs of patients initiating biologic and nonbiologic DMARDs from the Medicaid cohort and 7,538 pairs from the commercial insurance cohort. During 73,389 person-years of active treatment with either biologic or nonbiologic DMARDs, 95 cases of high-grade cervical dysplasia or cervical cancer occurred in the 2 cohorts. The HR for high-grade cervical dysplasia or cervical cancer associated with biologic DMARD use was 1.25 (95% confidence interval [95% CI] 0.78-2.01) in the Medicaid cohort and 1.63 (95% CI 0.62-4.27) in the commercial insurance cohort, with a pooled HR of 1.32 (95% CI 0.86-2.01). The rate of gynecologic procedures involving the uterine cervix was not different between the 2 groups (pooled RR 0.96 [95% CI 0.90-1.02]). Conclusion Among women with RA, initiation of therapy with a biologic DMARD was associated with a numerically significant, but not statistically significant, increase in the risk of high-grade cervical dysplasia or cervical cancer as compared to initiation of a nonbiologic DMARD. [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.)

المؤلفون: Solomon, Daniel H., Lee, Sara B., Zak, Agnes, Corrigan, Cassandra, Agosti, Jenifer, Bitton, Asaf, Harrold, Leslie, Losina, Elena, Lu, Bing, Pincus, Ted, Radner, Helga, Smolen, Josef, Katz, Jeffrey N, Fraenkel, Liana

المصدر: Seminars in Arthritis & Rheumatism; Aug2016, Vol. 46 Issue 1, p81-87, 7p

مستخلص: Background/purpose Treat-to-target (TTT) is a recommended strategy in the management of rheumatoid arthritis (RA), but various data sources suggest that its uptake in routine care in the US is suboptimal. Herein, we describe the design of a randomized controlled trial of a Learning Collaborative to facilitate implementation of TTT. Methods We recruited 11 rheumatology sites from across the US and randomized them into the following two groups: one received the Learning Collaborative intervention in Phase 1 (month 1–9) and the second formed a wait-list control group to receive the intervention in Phase 2 (months 10–18). The Learning Collaborative intervention was designed using the Model for Improvement, consisting of a Change Package with corresponding principles and action phases. Phase 1 intervention practices had nine learning sessions, collaborated using a web-based tool, and shared results of plan–do–study–act cycles and monthly improvement metrics collected at each practice. The wait-list control group sites had no intervention during Phase 1. The primary trial outcome is the implementation of TTT as measured by chart review, comparing the differences from baseline to end of Phase 1, between intervention and control sites. Results All intervention sites remained engaged in the Learning Collaborative throughout Phase 1, with a total of 38 providers participating. The primary trial outcome measures are currently being collected by the study team through medical record review. Conclusions If the Learning Collaborative is an effective means for improving implementation of TTT, this strategy could serve as a way of implementing disseminating TTT more widely. [ABSTRACT FROM AUTHOR]

: Copyright of Seminars in Arthritis & Rheumatism is the property of W B Saunders 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.)

المؤلفون: Solomon, Daniel H., Fraenkel, Liana, Lu, Bing, Brown, Erika, Tsao, Peter, Losina, Elena, Katz, Jeffrey N., Bitton, Asaf

المصدر: Arthritis Care & Research; Dec2015, Vol. 67 Issue 12, p1664-1670, 7p

مصطلحات موضوعية: RHEUMATOID arthritis diagnosis, RHEUMATOID arthritis treatment, CHI-squared test, COMPARATIVE studies, HEALTH care teams, INFLAMMATORY mediators, RESEARCH methodology, EVALUATION of medical care, MEDICAL cooperation, MEDICAL specialties & specialists, NURSE practitioners, PHYSICIANS, PHYSICIANS' assistants, REGRESSION analysis, RESEARCH, RESEARCH funding, RHEUMATOID arthritis, RHEUMATOLOGY, TIME, EVALUATION research, TREATMENT effectiveness, DISEASE remission, SEVERITY of illness index, ODDS ratio

مصطلحات جغرافية: UNITED States

مستخلص: Objective: The Affordable Care Act proposes wider use of nurse practitioners (NPs) and physician assistants (PAs), but little is known about outcomes of care provided by them in medical specialties. We compared the outcomes of care for patients with rheumatoid arthritis (RA) seen in practices with NPs or PAs and rheumatologists versus practices with rheumatologists only.Methods: We enrolled 7 rheumatology practices in the US (4 with NPs or PAs and 3 without). RA disease activity (categorized as in remission, low, moderate, or high, using standardized measures) was abstracted from medical records from the most recent 2 years. We performed a repeated-measures analysis using generalized linear regression to compare disease activity for visits to practices with NPs or PAs versus rheumatologist-only practices, adjusting for disease duration, serologic status, RA treatments, and disease activity measures.Results: Records from 301 patients, representing 1,982 visits, were reviewed. The patients' mean age was 61 years and 77% were female. In the primary adjusted analysis, patients seen in practices with NPs or PAs were less likely to have higher disease activity (odds ratio 0.32, 95% confidence interval 0.17-0.60; P = 0.004) than those seen in rheumatologist-only practices. However, there were no differences in the change in disease activity.Conclusion: Patients seen in practices with NPs or PAs had lower RA disease activity over 2 years compared to those seen in rheumatologist-only practices; no differences were observed in the change in disease activity between visits either within or between the different types of provider practice. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research 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.)

المؤلفون: Elman, Scott A., Yan Dong, Stenquist, Derek S., Ghazinouri, Roya, Alcantara, Luis, Collins, Jamie E., Beagan, Carolyn, Thornhill, Thomas S., Katz, Jeffrey N.

المصدر: BMC Musculoskeletal Disorders; 2014, Vol. 15 Issue 1, p2-21, 20p, 3 Charts, 1 Graph

مصطلحات موضوعية: PHYSICAL activity, POSTOPERATIVE period, ARTHROPLASTY, TOTAL hip replacement, TOTAL knee replacement, JOINT surgery

مصطلحات جغرافية: DOMINICAN Republic

مستخلص: Background To address both the growing burden of joint disease and the gaps in medical access in developing nations, medical relief organizations have begun to launch programs to perform total joint replacement (TJR) on resident populations in developing countries. One outcome of TJR of particular interest is physical activity (PA) since it is strongly linked to general health. This study evaluates the amount of postoperative participation in PA in low-income patients who received total joint replacement in the Dominican Republic and identifies preoperative predictors of postoperative PA level. Methods We used the Yale Physical Activity Survey (YPAS) to assess participation in postoperative PA 1-4 years following total knee or hip replacement. We compared the amount of aerobic PA reported by postoperative TJR patients with the levels of PA recommended by the CDC and WHO. We also analyzed preoperative determinants of postoperative participation in aerobic PA in bivariate and multivariate analyses. Results 64 patients out of 170 eligible subjects (52/128 TKR and 14/42 THR) who received TJR between 2009-2012 returned for an annual follow-up visit in 2013, with a mean treatment-tofollow- up time of 2.1 years. 43.3% of respondents met CDC/WHO criteria for sufficient participation in aerobic PA. Multivariate analyses including data from 56 individuals identified that patients who were both younger than 65 and at least two years postoperative had an adjusted mean activity dimensions summary index (ADSI) 22.9 points higher than patients who were 65 or older and one year postoperative. Patients who lived with friends or family had adjusted mean ADSI 17.2 points higher than patients living alone. Patients who had the most optimistic preoperative expectations of outcome had adjusted mean ADSI scores that were 19.8 points higher than those who were less optimistic. Conclusion The TJR patients in the Dominican cohort participate in less PA than recommended by the CDC/WHO. Additionally, several associations were identified that potentially affect PA in this population; specifically, participants who are older than 65, recently postoperative, less optimistic about postoperative outcomes and who live alone participate in less PA. [ABSTRACT FROM AUTHOR]

: Copyright of BMC Musculoskeletal Disorders is the property of BioMed Central 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.)

المؤلفون: Solomon, Daniel H., Bitton, Asaf, Katz, Jeffrey N., Radner, Helga, Brown, Erika M., Fraenkel, Liana

المصدر: Arthritis & Rheumatology; Apr2014, Vol. 66 Issue 4, p775-782, 8p

مصطلحات موضوعية: GOAL (Psychology), MEDICAL protocols, RHEUMATOID arthritis, DECISION making in clinical medicine, DISEASE remission

مستخلص: The article discusses the increase use of armamentarium as a treatment for rheumatoid arthritis (RA) along with the development of targeted biologic and nonbiologic disease-modifying antirheumatic drugs (DMARDs). It states that both drugs help reduce the disease activity that enhances long-term structural and quality of life outcomes. It examines the DMARD use patterns for treat to target (TTT) in clinical practice.