Treat-to-target in RA: Collaboration To Improve adOption and adhereNce (TRACTION)

Twelve rheumatology practices around the U.S. will be recruited to participate in a Learning Collaborative (LC). Eligible practices will have at least 50 rheumatoid arthritis patients, at least 2 rheumatologists, and an electronic medical record or typed notes. Each practice will be randomized to receive the intervention in either phase 1 (first 9 months) or phase 2 (second 9 months).

The collaborative will consist of a series of 9 Learning Sessions (1 conducted face-to-face, the remaining conducted via webinar) as well as regular coaching sessions and collaborative sessions. The structure of the collaborative will be such that each learning session will focus on resources, expertise, and best practices that address common barriers to Treat-to-Target (TTT) adoption. The follow-up coaching and collaborative sessions will give providers the opportunity to reflect on what they have learned from their own practices and from each other.

The first Learning Session was a one-day face-to-face meeting that consisted of orienting the teams to the Model for Improvement, describing the Change Package and its content, conducting team building activities focused on developing ideas for plan-do-study-act (PDSA) cycles, and cross-team learning activities. (The PDSA cycles refer to tests of change, using four stages, that are performed as part of a quality improvement process.) The day primarily consisted of discussion sessions, and several lectures on TTT, disease activity measures, and shared decision making helped orient teams to the Change Package contents. There was ample time for teams to get feedback from expert faculty on their proposed tests of change and results to date. Subsequent Learning Sessions were conducted via webinar.

We developed a web-based collaborative tool for the Learning Collaborative. It helped manage contents being shared across teams (i.e., key resources, PDSAs), displayed monthly improvement metrics, and provided a discussion board with conversation "threads." The tool was used in all Learning Sessions.

Specific patient data will never be identified in the sessions of the Collaborative, and no specific patient data will be shared between the participating providers. Providers will be able to interact with each other to share general practice patterns and behaviors, but sensitive patient information will not be shared.