Ab1629-HPR Optimizing Rheumatoid Arthritis Treat-to-Target Care by Using Patient-Reported Outcomes (Pros) to Assess and Improve Disease Management

Background: Treat-to-target (T2T) is the recommended disease-management strategy for rheumatoid arthritis (RA). T2T relies on shared decision-making that should include use of patient-reported outcomes (PROs) that may be captured electronically (ePROs). PROs/ePROs complement clinical measures of disease activity and can help clinicians understand symptoms and health status from the patient's perspective (e.g., pain, function, and quality of life overall and in response to treatment changes). Because PROs are typically collected at in-person visits, a gap in determining how to integrate the T2T approach using PROs/ePROs in clinical practice to inform decision-making may have been amplified with the recent uptake in telehealth and virtual management of chronic conditions. Objectives: To characterize current perspectives, challenges, and solutions for implementing and sustaining PRO/ePRO-based T2T strategies as part of RA patient care. Methods: A targeted literature review was conducted for articles published from November 2014 to December 2022 on use of PROs/ePROs in T2T RA care in ambulatory or outpatient settings in the United States to inform content of a focus group. The focus group was designed to discuss challenges and solutions for implementing PROs/ePROs in clinical settings; was convened virtually in March 2023; and consisted of a multidisciplinary panel (rheumatologist physician assistant; infusion services director; population health leader; rheumatologist/innovation leader; clinic office manager; clinical informaticist/pharmacist; rheumatologist/immunologist; and key opinion leader rheumatologist). Results: Key findings from the 20 relevant articles identified during the literature review included low adherence to T2T by patients and clinicians that was in part due to lack of patient-centered care and low patient involvement in treatment decision-making. The considerable amount of time required for clinicians to conduct assessments and not enough patient engagement and inadequate shared decision-making were considered barriers to T2T strategies that may be overcome in part by use of PROs/ePROs. While multiple mechanisms for collecting PRO/ePRO data were identified, a major challenge was low patient and clinician commitment to collect and use such data. The focus group confirmed and expanded on these challenges and suggested solutions (Table 1). Focus group participants also noted that while clinicians who use T2T value its benefits for improving patient outcomes and increasing efficiency and productivity of clinic workflows, few clinical practices use out-of-office mechanisms to support key elements of T2T strategies. Toward this goal, ePROs, especially if combined with remote therapeutic monitoring, were considered useful for visit triage (i.e., to accelerate or postpone already scheduled clinical visits), and complementary use of a PRO with a clinical disease activity measure in a proposed decision tree (Figure 1) could enhance the shared decision-making process in T2T strategies. A key concept for enhancing systematic use of PROs/ePROs was integrating ePROs into electronic health records to reduce manual data entry. Similarly, key practical considerations for implementing sustainable PRO/ePRO capture were improving communication between clinicians and patients regarding how and why the collected data are being used and a greater role for these data in the shared decision-making process. Conclusion: While challenges for T2T and PRO implementation were clinician time restrictions, information technology integration issues, and lack of patient understanding, education and incentivization of clinicians and patients may help integrate PROs/ePROs into workflow without adding administrative burden. Clinicians and health systems can apply these findings toward development of pathways and workflows that would facilitate widespread adoption of PRO-based T2T strategies for RA to improve disease management and patient outcomes. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Merrion Buckley Pfizer, Jeffrey R Curtis Pfizer, Saira Haque Pfizer, Jason Lynn Pfizer, Hesper Chan: None declared, Mary E. Bowler: None declared, Jeff Vawter: None declared, Michele L. Arling: None declared, Cate Polacek: None declared, Jasmin Thompson: None declared, Maisha Freeman Pfizer, Elizabeth MacLean Pfizer, Rena Coll Pfizer.