title: Implementation of treat-to-target in rheumatoid arthritis through a Learning Collaborative: Rationale and design of the TRACTION trial.
abstract: Treat-to-target (TTT) is a recommended strategy in the management of rheumatoid arthritis (RA), but various data sources suggest that its uptake in routine care in the US is suboptimal. Herein, we describe the design of a randomized controlled trial of a Learning Collaborative to facilitate implementation of TTT.
  
  
  
  We recruited 11 rheumatology sites from across the US and randomized them into the following two groups: one received the Learning Collaborative intervention in Phase 1 (month 1-9) and the second formed a wait-list control group to receive the intervention in Phase 2 (months 10-18). The Learning Collaborative intervention was designed using the Model for Improvement, consisting of a Change Package with corresponding principles and action phases. Phase 1 intervention practices had nine learning sessions, collaborated using a web-based tool, and shared results of plan-do-study-act cycles and monthly improvement metrics collected at each practice. The wait-list control group sites had no intervention during Phase 1. The primary trial outcome is the implementation of TTT as measured by chart review, comparing the differences from baseline to end of Phase 1, between intervention and control sites.
  
  
  
  All intervention sites remained engaged in the Learning Collaborative throughout Phase 1, with a total of 38 providers participating. The primary trial outcome measures are currently being collected by the study team through medical record review.
  
  
  
  If the Learning Collaborative is an effective means for improving implementation of TTT, this strategy could serve as a way of implementing disseminating TTT more widely.
authors.affiliation: Division of Rheumatology, Brigham and Women׳s Hospital, Boston, MA. Electronic address: dsolomon@partners.org.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.affiliation: Division of Rheumatology, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Sara B
authors.initials: SB
authors.lastname: Lee
authors.affiliation: Division of Rheumatology, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Agnes
authors.initials: A
authors.lastname: Zak
authors.affiliation: Division of Rheumatology, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Corrigan
authors.affiliation: JRA Consulting, North Andover, MA.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Agosti
authors.affiliation: Division of General Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
authors.affiliation: Department of Orthopaedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Harrold
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.affiliation: Division of Rheumatology, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Bing
authors.initials: B
authors.lastname: Lu
authors.affiliation: Division of Rheumatology, Rush Medical School, Chicago, IL.
authors.forename: Ted
authors.initials: T
authors.lastname: Pincus
authors.affiliation: Division of Rheumatology, University of Vienna, Vienna, Austria.
authors.forename: Helga
authors.initials: H
authors.lastname: Radner
authors.affiliation: Division of Rheumatology, University of Vienna, Vienna, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Smolen
authors.affiliation: Division of Rheumatology, Brigham and Women׳s Hospital, Boston, MA; Department of Orthopaedic Surgery, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.affiliation: Division of Rheumatology, Yale School of Medicine, West Haven Veterans Affairs Health System, New Haven, CT.
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
mesh_terms: D001172:Arthritis, Rheumatoid / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D011320:Primary Health Care; D012107:Research Design; D012219:Rheumatology
keywords: Learning collaborative; Quality improvement; Randomized controlled trial; Rheumatoid arthritis; Treat to target