2247 Pope, et al: Education and RA treatment Personal non-commercial use only. The Journal of Rheumatology Copyright © 2012. All rights reserved. Effect of Rheumatologist Education on Systematic Measurements and Treatment Decisions in Rheumatoid Arthritis: The Metrix Study JANET POPE, CARTER THORNE, ALFRED CIVIDINO, and KURT LUCAS ABSTRACT. 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. (First Release Oct 15 2012; J Rheumatol 2012;39:2247–52; doi:10.3899/ jrheum.120597) Key Indexing Terms: EDUCATION KNOWLEDGE TRANSLATION EXCHANGE RHEUMATOID ARTHRITIS CHART AUDIT SMALL GROUP LEARNING COMPARATIVE FEEDBACK From the Department of Rheumatology, St. Joseph’s Health Care, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario; McMaster University, Hamilton, Ontario; and Extension Marketing, Montreal, Quebec, Canada. Funded by an education grant from Abbott Canada. J. Pope, MD, MPH, FRCPC, Department of Rheumatology, St. Joseph’s Health Care; C. Thorne, MD, FRCPC, Southlake Regional Health Centre; A. Cividino, MD, FRCPC, McMaster University; K. Lucas, BSc, MSc Pharm, Extension Marketing. Address correspondence to Dr. J. Pope, St. Joseph’s Health Care, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada. E-mail: janet.pope@sjhc.london.on.ca Accepted for publication August 27, 2012. Multiple studies have demonstrated that treating to a target in rheumatoid arthritis (RA) leads to more patients reaching that target and thus is likely to translate into better care 1,2,3,4,5,6,7,8,9 . However, to change clinical practice behavior is a challenge. Practice guidelines, for instance, are followed only about half the time 10,11 . The reason for this may be a knowledge gap, or more likely a gap between knowledge and behavioral change. We devised a ran- domized trial to determine whether comparative feedback from chart audits and targeted small-group learning (especially targeted toward breaking down barriers to good care) would alter behavior, compared with solely performing chart audits without feedback. We combined an educational small-group learning program with a chart audit that compared an individual’s practice to other rheumatologists to see whether this would change behavior in the assessment and management of RA. A review by Jamtvedt, et al has shown that audit and feedback intervention approaches can be effective in improving patient care and adherence to guidelines, especially if original adherence to guidelines is minimal and intensive feedback is provided, but the effects may be small to moderate 12 . Another review concluded that reminders, patient-mediated interventions, outreach visits, opinion leaders, and multifaceted activities could change physician behavior more effectively than traditional continuing medical education (CME) events, but of the interventions, chart audit with feedback and educational materials were www.jrheum.org Downloaded on June 19, 2022 from