Tala El Tal1, Meghan E Ryan2, Brian M Feldman1, Catherine April Bingham3, Jon M Burnham4, Michelle Batthish5, Danielle Bullock2, Kerry Ferraro, Mileka Gilbert6, Miriah Gillispie-Taylor7, Beth Gottlieb8, Julia G Harris9, Melissa Hazen10, Ronald M Laxer1, Tzielan Chang Lee11, Daniel Lovell12, Melissa Mannion13, Laura Noonan14, Edward Oberle15, Janalee Taylor12, Jennifer E Weiss16, Cagri Yildirim Toruner7, Esi M Morgan17. 1. T. El Tal, MD, B.M. Feldman, MD, PhD, R.M. Laxer, MD, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada. 2. M.E. Ryan, DO, D. Bullock, MD, University of Minnesota, Minneapolis, Minnesota, USA. 3. C.A. Bingham, MD, Penn State Children's Hospital, Hershey, Pennsylvania, USA. 4. J.M. Burnham, MD, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 5. M. Batthish, MD, McMaster University, Hamilton, Ontario, Canada. 6. M. Gilbert, MD, Medical University of South Carolina, Charleston, South Carolina, USA. 7. M. Gillispie-Taylor, MD, C. Yildirim Toruner, MD, Texas Children's Hospital Baylor College of Medicine, Houston, Texas, USA. 8. B. Gottlieb, MD, Cohen Children's Medical Center, Lake Success, New York, USA. 9. J.G. Harris, MD, Children's Mercy Kansas City, Kansas City, Kansas, USA. 10. M. Hazen, MD, Boston Children's Hospital, Boston, Massachusetts, USA. 11. T.C. Lee, MD, Stanford Children's Health, Palo Alto, California, USA. 12. D. Lovell, MD, J. Taylor, CNP, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 13. M. Mannion, MD, University of Alabama at Birmingham, Birmingham, Alabama, USA. 14. L. Noonan, MD, Levine Children's Hospital/Carolinas Healthcare System, Charlotte, North Carolina, USA. 15. E. Oberle, MD, Nationwide Children's Hospital, Columbus, Ohio, USA. 16. J.E. Weiss, MD, Hackensack University Medical Center, Hackensack, Hackensack, New Jersey, USA. 17. E.M. Morgan, MD, MSCE, University of Washington, and Seattle Children's Hospital, Seattle, Washington, USA.
Abstract
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.
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.
Authors: Meghan E Ryan; Andrew Warmin; Bryce A Binstadt; Colleen K Correll; Emily Hause; Patricia Hobday; Alison Lerman; Shawn A Mahmud; Mona M Riskalla; Zachary Shaheen; Richard K Vehe; Danielle R Bullock Journal: Pediatr Rheumatol Online J Date: 2022-09-29 Impact factor: 3.413