title: Impact of rheumatoid arthritis disease activity test on clinical practice.
abstract: BACKGROUND
  Variability exists in the assessment of disease activity in rheumatoid arthritis (RA) patients that may affect quality of care.
  
  
  OBJECTIVE
  To measure the impact on quality of care of a Multi-Biomarker Disease Activity (MBDA) test that quantitatively assesses RA disease activity.
  
  
  METHODS
  Board-certified rheumatologists without prior experience with the MBDA test (N = 81) were randomized into an intervention or control group as part of a longitudinal randomized-control study. All physicians were asked to care for three simulated RA patients, using Clinical Performance and Value (CPV™) vignettes, in a before and after design. CPV™ vignettes have been validated to assess the quality of clinical practice and identify variation in care. The vignettes covered all domains of a regular patient visit; scores were determined as a percentage of explicit predefined criteria completed. Three vignettes, representing typical RA cases, were administered each round. In the first round, no physician received information about the MBDA test. In the second round, only physicians in the intervention group were given educational materials about the test and hypothetical test results for each of the simulated patients. The outcome measures were the overall quality of care, disease assessment and treatment.
  
  
  RESULTS
  The overall quality scores in the intervention group improved by 3 percent (p = 0.02) post-intervention compared with baseline, versus no change in the control group. The greatest benefit in the intervention group was to the quality of disease activity assessment and treatment decisions, which improved by 12 percent (p<0.01) compared with no significant change in the control group. The intervention was associated with more appropriate use of biologic and/or combination DMARDs in the co-morbidity case type (p<0.01).
  
  
  CONCLUSIONS
  Based on these results, use of the MBDA test improved the assessment and treatment decisions for simulated cases of RA and may prove useful for rheumatologists in clinical practice.
authors.affiliation: Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America. jpeabody@qurehealthcare.com
authors.forename: John W
authors.initials: JW
authors.lastname: Peabody
authors.forename: Vibeke
authors.initials: V
authors.lastname: Strand
authors.forename: Riti
authors.initials: R
authors.lastname: Shimkhada
authors.forename: Rachel
authors.initials: R
authors.lastname: Lee
authors.forename: David
authors.initials: D
authors.lastname: Chernoff
mesh_terms: D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis* / Q000473:pathology*; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010820:Physicians; D010818:Practice Patterns, Physicians'
chemical_list: D015415:Biomarkers