Effect of rheumatologist education on systematic measurements and treatment decisions in rheumatoid arthritis: the metrix study.
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).


CONCLUSIONS
Small-group learning with feedback from practice audits is an inexpensive way to improve outcomes in RA.
Department of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada. janet.pope@sjhc.london.on.ca
Janet
J
Pope
Carter
C
Thorne
Alfred
A
Cividino
Kurt
K
Lucas
D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006126:Group Processes; D055991:Health Records, Personal; D006304:Health Status; D006801:Humans; D008297:Male; D008485:Medical Audit; D010353:Patient Education as Topic; D011364:Professional Practice; D011446:Prospective Studies; D011788:Quality of Life; D012219:Rheumatology / Q000193:education*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires