Learning Collaborative Model Improves Treat-to-Target Documentation in RA

patient listening intently to a male doctor explaining patient symptoms or asking a question as they discuss paperwork together in a consultation.
Investigators found data that showed that the documentation of a treat-to-target approach in rheumatoid arthritis was improved by a learning collaborative intervention with participation by rheumatologists and their patients.

A multidisciplinary learning collaborative model was found to improve the implementation of treat-to-target documentation among rheumatologists, according to research findings published in Arthritis Care & Research.

The researchers conducted a nonrandomized interrupted time-series study that included 554 patients with rheumatoid arthritis (RA). Study participants completed the Routine Assessment of Patient Index Data 3 (RAPID-3) patient-reported outcome questionnaire at baseline. In total, 9 rheumatologists were assigned to the learning collaborative intervention arm and 13 were assigned to the control arm. The primary outcome measured was rheumatologist documentation of treat-to-target implementation score, with an interrupted time-series analysis used to examine patient visits at which a medication change occurred.

Related Articles

After analysis, the researchers found that treat-to-target implementation scores were significantly higher in the intervention arm compared with the control arm (44.6% vs 32.2%, respectively; P <.0001).

With respect to component scores, significantly higher treat-to-target implementation scores were observed in all subgroups when comparing rheumatologists in the intervention arm with the control arm.

“We found that medication changes were 54% less likely in patients of the intervention rheumatologists compared to the control rheumatologists’ patients (odds ratio, 0.46; 95% CI, 0.26-0.79; P =.005),” the researchers wrote.

One key study limitation was its nonrandomized single-center design.

“The optimal target for treating RA remains elusive, but our goal is to spread our learning to our control rheumatologists and trainees to continue to adopt treat-to-target in our care of RA patients,” they concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Desai S, Leatherwood C, Forman M, et al. Treat-to-target in rheumatoid arthritis: a quality improvement trial [published online November 23, 2019]. Arthritis Care Res. doi:10.1002/acr.24114