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Research ArticlePediatric Rheumatology

Consensus Approach to a Treat-to-target Strategy in Juvenile Idiopathic Arthritis Care: Report From the 2020 PR-COIN Consensus Conference

Tala El Tal, Meghan E. Ryan, Brian M. Feldman, Catherine April Bingham, Jon M. Burnham, Michelle Batthish, Danielle Bullock, Kerry Ferraro, Mileka Gilbert, Miriah Gillispie-Taylor, Beth Gottlieb, Julia G. Harris, Melissa Hazen, Ronald M. Laxer, Tzielan Chang Lee, Daniel Lovell, Melissa Mannion, Laura Noonan, Edward Oberle, Janalee Taylor, Jennifer E. Weiss, Cagri Yildirim Toruner and Esi M. Morgan
The Journal of Rheumatology May 2022, 49 (5) 497-503; DOI: https://doi.org/10.3899/jrheum.210709
Tala El Tal
1T. El Tal, MD, B.M. Feldman, MD, PhD, R.M. Laxer, MD, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada;
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  • ORCID record for Tala El Tal
Meghan E. Ryan
2M.E. Ryan, DO, D. Bullock, MD, University of Minnesota, Minneapolis, Minnesota, USA;
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Brian M. Feldman
1T. El Tal, MD, B.M. Feldman, MD, PhD, R.M. Laxer, MD, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada;
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Catherine April Bingham
3C.A. Bingham, MD, Penn State Children’s Hospital, Hershey, Pennsylvania, USA;
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  • ORCID record for Catherine April Bingham
Jon M. Burnham
4J.M. Burnham, MD, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA;
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Michelle Batthish
5M. Batthish, MD, McMaster University, Hamilton, Ontario, Canada;
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  • ORCID record for Michelle Batthish
Danielle Bullock
2M.E. Ryan, DO, D. Bullock, MD, University of Minnesota, Minneapolis, Minnesota, USA;
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Kerry Ferraro
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Mileka Gilbert
6M. Gilbert, MD, Medical University of South Carolina, Charleston, South Carolina, USA;
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  • ORCID record for Mileka Gilbert
Miriah Gillispie-Taylor
7M. Gillispie-Taylor, MD, C. Yildirim Toruner, MD, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA;
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Beth Gottlieb
8B. Gottlieb, MD, Cohen Children’s Medical Center, Lake Success, New York, USA;
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Julia G. Harris
9J.G. Harris, MD, Children’s Mercy Kansas City, Kansas City, Kansas, USA;
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Melissa Hazen
10M. Hazen, MD, Boston Children’s Hospital, Boston, Massachusetts, USA;
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  • ORCID record for Melissa Hazen
Ronald M. Laxer
1T. El Tal, MD, B.M. Feldman, MD, PhD, R.M. Laxer, MD, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada;
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Tzielan Chang Lee
11T.C. Lee, MD, Stanford Children’s Health, Palo Alto, California, USA;
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Daniel Lovell
12D. Lovell, MD, J. Taylor, CNP, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA;
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Melissa Mannion
13M. Mannion, MD, University of Alabama at Birmingham, Birmingham, Alabama, USA;
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Laura Noonan
14L. Noonan, MD, Levine Children’s Hospital/Carolinas Healthcare System, Charlotte, North Carolina, USA;
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Edward Oberle
15E. Oberle, MD, Nationwide Children’s Hospital, Columbus, Ohio, USA;
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Janalee Taylor
12D. Lovell, MD, J. Taylor, CNP, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA;
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Jennifer E. Weiss
16J.E. Weiss, MD, Hackensack University Medical Center, Hackensack, Hackensack, New Jersey, USA;
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Cagri Yildirim Toruner
7M. Gillispie-Taylor, MD, C. Yildirim Toruner, MD, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA;
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Esi M. Morgan
17E.M. Morgan, MD, MSCE, University of Washington, and Seattle Children’s Hospital, Seattle, Washington, USA.
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Abstract

Objective Treat to target (T2T) is a strategy of adjusting treatment until a target is reached. An international task force recommended T2T for juvenile idiopathic arthritis (JIA) treatment. Implementing T2T in a standard and reliable way in clinical practice requires agreement on critical elements of (1) target setting, (2) T2T strategy, (3) identifying barriers to implementation, and (4) patient eligibility. A consensus conference was held among Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) stakeholders to inform a statement of understanding regarding the PR-COIN approach to T2T.

Methods PR-COIN stakeholders including 16 healthcare providers and 4 parents were invited to form a voting panel. Using the nominal group technique, 2 rounds of voting were held to address the above 4 areas to select the top 10 responses by rank order.

Results Incorporation of patient goals ranked most important when setting a treatment target. Shared decision making (SDM), tracking measurable outcomes, and adjusting treatment to achieve goals were voted as the top elements of a T2T strategy. Workflow considerations, and provider buy-in were identified as key barriers to T2T implementation. Patients with JIA who had poor prognostic factors and were at risk for high disease burden were leading candidates for a T2T approach.

Conclusion This consensus conference identified the importance of incorporating patient goals as part of target setting and of the influence of patient stakeholder involvement in drafting treatment recommendations. The network approach to T2T will be modified to address the above findings, including solicitation of patient goals, optimizing SDM, and better workflow integration.

Key Indexing Terms:
  • disease activity score
  • juvenile idiopathic arthritis
  • outcomes
  • physician practice patterns
  • practice guidelines
  • registries
  • Accepted for publication January 21, 2022.
  • Copyright © 2022 by the Journal of Rheumatology
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Consensus Approach to a Treat-to-target Strategy in Juvenile Idiopathic Arthritis Care: Report From the 2020 PR-COIN Consensus Conference
Tala El Tal, Meghan E. Ryan, Brian M. Feldman, Catherine April Bingham, Jon M. Burnham, Michelle Batthish, Danielle Bullock, Kerry Ferraro, Mileka Gilbert, Miriah Gillispie-Taylor, Beth Gottlieb, Julia G. Harris, Melissa Hazen, Ronald M. Laxer, Tzielan Chang Lee, Daniel Lovell, Melissa Mannion, Laura Noonan, Edward Oberle, Janalee Taylor, Jennifer E. Weiss, Cagri Yildirim Toruner, Esi M. Morgan
The Journal of Rheumatology May 2022, 49 (5) 497-503; DOI: 10.3899/jrheum.210709

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Consensus Approach to a Treat-to-target Strategy in Juvenile Idiopathic Arthritis Care: Report From the 2020 PR-COIN Consensus Conference
Tala El Tal, Meghan E. Ryan, Brian M. Feldman, Catherine April Bingham, Jon M. Burnham, Michelle Batthish, Danielle Bullock, Kerry Ferraro, Mileka Gilbert, Miriah Gillispie-Taylor, Beth Gottlieb, Julia G. Harris, Melissa Hazen, Ronald M. Laxer, Tzielan Chang Lee, Daniel Lovell, Melissa Mannion, Laura Noonan, Edward Oberle, Janalee Taylor, Jennifer E. Weiss, Cagri Yildirim Toruner, Esi M. Morgan
The Journal of Rheumatology May 2022, 49 (5) 497-503; DOI: 10.3899/jrheum.210709
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Keywords

DISEASE ACTIVITY SCORE
JUVENILE IDIOPATHIC ARTHRITIS
OUTCOMES
PHYSICIAN PRACTICE PATTERNS
PRACTICE GUIDELINES
REGISTRIES

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Keywords

  • disease activity score
  • juvenile idiopathic arthritis
  • outcomes
  • physician practice patterns
  • practice guidelines
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