Evaluation of a novel EHR sidecar application to display RA clinical outcomes during clinic visits: results of a stepped‐wedge cluster randomized pragmatic trial

Objective We developed a novel EHR sidecar application to visualize key rheumatoid arthritis (RA) outcomes, including disease activity, physical function, and pain, via a patient‐facing graphical interface designed for use during outpatient visits (“RA PRO dashboard”). Initial qualitative studies showed positive perceptions from patients; here we assessed the effect of the RA PRO dashboard on patient decision‐making, self‐efficacy in symptom management, medication beliefs, and medication adherence in a randomized pragmatic trial. Methods We conducted an open cohort, stepped‐wedge cluster‐randomized trial at a single academic rheumatology clinic between February 2020 and August 2023. Rheumatology clinicians were randomized as clinician‐patient clusters into four intervention sequences (5 time periods). Primary outcome measures derived from patient questionnaires: 4‐item SURE scale of decisional conflict; PROMIS‐SE 4a – Self‐Efficacy for Managing Symptoms; Beliefs about Medicines Questionnaire – Specific Necessity‐Concerns differential; and medication adherence. Generalized estimating equations models were used to evaluate the effect of clinician access to the dashboard on each outcome. Results 23 clinicians were included in the analysis. 554 patients completed 1083 study visits, of which 664 were in the intervention group. Adoption of the RA PRO dashboard by clinicians was highly variable. We observed limited effects of the intervention on the outcomes. Conclusions This trial revealed no significant short‐term effects of the RA PRO dashboard on measures of patient decision‐making, self‐efficacy, medication beliefs, or adherence. Despite prior qualitative work showing improvements in the care experience, this study suggests that the dashboard's impact on traditional behavioral outcomes, at least in the short term, is limited.