Implementation of treat-to-target in rheumatoid arthritis through a Learning Collaborative: Rationale and design of the TRACTION trial.
Implementation of treat-to-target in rheumatoid arthritis through a Learning Collaborative: Rationale and design of the TRACTION trial.
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DOI：
10.1016/j.semarthrit.2016.02.009
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发表时间：
2016-08
影响因子：
5
通讯作者：
Fraenkel L
中科院分区：
文献类型：
--
作者：
Solomon DH;Lee SB;Zak A;Corrigan C;Agosti J;Bitton A;Harrold L;Losina E;Lu B;Pincus T;Radner H;Smolen J;Katz JN;Fraenkel L
靶向治疗(TTT)是治疗类风湿性关节炎(RA)的推荐策略，但各种数据来源表明，在美国的常规护理中，TTT的使用率并不理想。在这里，我们描述了一个学习协作的随机对照试验的设计，以促进TTT的实施。我们从美国各地招募了11个风湿病网站，并将他们随机分为两组：一组在第一阶段(1-9个月)接受学习协作干预，另一组在第二阶段(10-18个月)接受干预，形成等待名单对照组。学习协作干预是使用改进模式设计的，由具有相应原则和行动阶段的改变方案组成。第一阶段干预实践有9次学习会议，使用基于网络的工具进行协作，并分享在每个实践中收集的计划-做-研究-行动周期和每月改进指标的结果。等待名单控制组站点在第一阶段期间没有干预。主要试验结果是通过图表回顾来衡量TTT的实施情况，比较从基线到第一阶段结束、干预站点和对照站点之间的差异。在整个第一阶段，所有干预站点都继续参与学习协作，共有38个提供者参与。研究小组目前正在通过医疗记录审查收集主要试验结果衡量标准。如果合作学习是改进TTT实施的有效手段，那么这一战略可以作为实施TTT的一种方式，从而更广泛地传播TTT。
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 sub-optimal. Herein, we describe the design of a randomized controlled trial of a Learning Collaborative to facilitate implementation of TTT. We recruited 11 rheumatology sites from across the US and randomized them into 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 9 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 implementation of TTT as measured by chart review, comparing the differences from baseline to end of Phase 1, between intervention and control sites. 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. 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.