PT  - JOURNAL ARTICLE
AU  - Janet Pope
AU  - Carter Thorne
AU  - Alfred Cividino
AU  - Kurt Lucas
TI  - Effect of Rheumatologist Education on Systematic Measurements and Treatment Decisions in Rheumatoid Arthritis: The Metrix Study
AID  - 10.3899/jrheum.120597
DP  - 2012 Oct 15
TA  - The Journal of Rheumatology
PG  - jrheum.120597
4099  - http://www.jrheum.org/content/early/2012/10/10/jrheum.120597.short
4100  - http://www.jrheum.org/content/early/2012/10/10/jrheum.120597.full
AB  - Objective To determine whether an educational intervention could result in changes in physicians’ practice behavior. Methods Twenty rheumatologists performed a prospective chart audit of 50 consecutive patients with rheumatoid arthritis (RA) and again after 6 months. Ten were randomized to the educational intervention: monthly Web-based conferences on the value of systematic assessments in RA, recent evidence-based information, practice efficiency, and other topics; this group also read articles on targeting care in RA. The others were randomized to no intervention. Results One thousand serial RA charts were audited at baseline and 1000 at 6 months, with no between-group differences in patient characteristics: mean disease duration of 10 years; 77% women; 74% rheumatoid factor-positive; mean Disease Activity Score (DAS) 3.7; and 68% taking methotrexate, 14% taking steroids, and 27% taking biologics. At 6 months the intervention group collected more global assessments (patient global 53% preintervention vs 66% postintervention, and MD global 51% vs 60%; p < 0.05) and Health Assessment Questionnaires (37% vs 42%; p > 0.05; p = nonsignificant), whereas controls had no change in outcomes collected. For the intervention group there was a 32% increase in calculable composite scores [such as DAS, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index; p < 0.05] but no change in the controls. There was more targeting to a low disease state. For those with SDAI between 3.3 and 11, the percentage of patients receiving a change in therapy was 66% in the intervention group and 36% in controls (p < 0.05). When DAS was between 2.4 and 3.6, 57% of the intervention group and 38% of controls made changes to treatment (p < 0.05). Conclusion Small-group learning with feedback from practice audits is an inexpensive way to improve outcomes in RA.