Implementation and Evaluation of Audit and Feedback for Monitoring Treat-to-Target (T2T) Strategies in Rheumatoid Arthritis Using Performance Measures

Abstract

Introduction: In collaboration with the Alberta Medical Association's Physician Learning Program we developed individualized physician reports and held a group feedback session on rheumatoid arthritis (RA) performance measures (PM) to facilitate treat-to-target (T2T) strategies and evaluated physician experiences with this process. Methods: 5 PMs addressing T2T concepts from an established Canadian quality framework were operationalized for physician practice reports at 2 university-affiliated rheumatology clinics. Rheum4U, a quality improvement and research platform, was the data source. The audit results were reviewed in a facilitated group feedback session. Rheumatologists provided experiential feedback on the process through survey and/or an interview. Transcripts from interviews were analyzed using a 6-step thematic analysis. Results: 11 of 12 eligible rheumatologists consented to receive practice reports and provided feedback through surveys (n = 5) and interviews (n = 6). The practice reports from Rheum4U

Identification of Five Quality Needs for Rheumatology (Text Analysis and Literature Review)

“…Indeed, one initiative to optimize T2T strategies using audit and group feedback for RA provided deep insights into the implementation process: T2T resulted in a high measurement rate of disease activity recorded by an electronic platform, with suboptimal follow-up times identified for patients without remission, especially for patients with long disease duration ( 36 ). Three areas for potential quality improvement were identified during the group feedback session: (1) expanding the use of an electronic data collection software, (2) the need for a protocol to manage early RA, and (3) expanding similar initiatives to patients with other diagnoses.…”

“…A link with data on drug dispensing in pharmacies should also be sought in order to be able to better estimate the actual point in time of treatment changes. The results of audits and feedback could then be used to drive quality improvements (36). (3) Role of nurses in rheumatologic care: Differences in the qualifications of rheumatology teams in different health systems determine the optimal use of the various professional groups and can also affect the quality of care provided to the patients (97).…”

“…A link with data on drug dispensing in pharmacies should also be sought in order to be able to better estimate the actual point in time of treatment changes. The results of audits and feedback could then be used to drive quality improvements ( 36 ).…”

“…Out of these publications, 1 article on structure (31), 7 articles on process (24,(32)(33)(34)(35)(36)(37) and 2 articles on outcome quality (31, 38) were identified. For the WHO-defined health goals, 1 article on physical (39), no article on psychological and 1 article on social issues (40) were identified.…”

The PICASO cloud platform for improved holistic care in rheumatoid arthritis treatment—experiences of patients and clinicians

“…Other dashboards and platforms designed to support rheumatologists have been developed [ 26 , 32 – 35 ]. Rheum4U offers PROM assessments and is valued for evaluations of treat to target efforts in RA [ 33 ], whereas Rheum-PACER integrates and reassembles information from four disparate PRO data sources into actionable views and functions [ 34 ]. The eHealth platform (Sanoia®), which enables RA patients’ self-assessment of health and disease status, led to a small improvement in patient-perceived patient-physician interactions [ 35 ], as we also observed in our PICASO study.…”