Objective. Treat to target (T2T) is a strategy of adjusting treatment until a target is reached. An international task force recommended T2T for juvenile idiopathic arthritis (JIA) treatment. Implementing T2T in a standard and reliable way in clinical practice requires agreement on critical elements of (1) target setting, (2) T2T strategy, (3) identifying barriers to implementation, and (4) patient eligibility. A consensus conference was held among Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) stakeholders to inform a statement of understanding regarding the PR-COIN approach to T2T. Methods. PR-COIN stakeholders including 16 healthcare providers and 4 parents were invited to form a voting panel. Using the nominal group technique, 2 rounds of voting were held to address the above 4 areas to select the top 10 responses by rank order. Results. Incorporation of patient goals ranked most important when setting a treatment target. Shared decision making (SDM), tracking measurable outcomes, and adjusting treatment to achieve goals were voted as the top elements of a T2T strategy. Workflow considerations, and provider buy-in were identified as key barriers to T2T implementation. Patients with JIA who had poor prognostic factors and were at risk for high disease burden were leading candidates for a T2T approach. Conclusion. This consensus conference identified the importance of incorporating patient goals as part of target setting and of the influence of patient stakeholder involvement in drafting treatment recommendations. The network approach to T2T will be modified to address the above findings, including solicitation of patient goals, optimizing SDM, and better workflow integration.
Bibliographical noteFunding Information:
PR-COIN Treat to Target Consensus Meeting activities were funded by PCORI grant RI-PCC-2017 “PCORnet Learning Healthcare System Network Collaborative” (Principal Investigator [PI] Peter Margolis) with subaward to Arthritis Foundation, to support a PARTNERS Learning Health System (LHS) to connect Arthritis Foundation (PI Guy Eakin, PhD) and patient engagement expertise, with PR-COIN (PI Esi M. Morgan, MD, MSCE) and QI expertise, and CARRA (PI Emily von Scheven, MD) and their research expertise to advance patient level outcomes in pediatric rheumatology. Funding of the meeting was approved by PCORI and PARTNERS LHS Executive Committee. We also acknowledge and appreciate the time and participation of speakers at the event (Jon M. Burnham, MD, MSCE, Alessandro Consolaro, MD, PhD, Julia G. Harris, MD, Casper Schoemaker, PhD, Joost Swart, MD, PhD), voting panel members (Supplementary Table 1, available with the online version of this article), facilitator Brian M. Feldman, MD, PhD, pollsters (Tala El Tal, MD, Meghan E. Ryan, DO, Kelsey Petrany), notetaker Janalee Taylor, CNP, and PR-COIN project manager Anne Paul, MBA.
This study was supported by Patient-Centered Outcomes Research Institute (PCORI) grant RI-PCC-2017. 1T. El Tal, MD, B.M. Feldman, MD, PhD, R.M. Laxer, MD, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada; 2M.E. Ryan, DO, D. Bullock, MD, University of Minnesota, Minneapolis, Minnesota, USA; 3C.A. Bingham, MD, Penn State Children’s Hospital, Hershey, Pennsylvania, USA; 4J.M. Burnham, MD, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; 5M. Batthish, MD, McMaster University, Hamilton, Ontario, Canada; 6M. Gilbert, MD, Medical University of South Carolina, Charleston, South Carolina, USA; 7M. Gillispie-Taylor, MD, C. Yildirim Toruner, MD, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA; 8B. Gottlieb, MD, Cohen Children’s Medical Center, Lake Success, New York, USA; 9J.G. Harris, MD, Children’s Mercy Kansas City, Kansas City, Kansas, USA; 10M. Hazen, MD, Boston Children’s Hospital, Boston, Massachusetts, USA; 11T.C. Lee, MD, Stanford Children’s Health, Palo Alto, California, USA;
© 2022 The Journal of Rheumatology.
- disease activity score
- juvenile idiopathic arthritis
- physician practice patterns
- practice guidelines
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't