Standardizing and Personalizing Patient-Centered Rheumatoid Arthritis Treatment Targets

Goals: To evaluate the added value of the Patient Reported Outcomes Measurement Information System (PROMIS) to an existing treat to target (T2T) rheumatoid arthritis (RA) treatment program, to use PROMIS to standardize the patient-centered targets of pain, fatigue, depression and physical function, and to individualize (personalize) these treatment targets. Target population: Adults with a documented RA diagnosis. We will enroll two groups of patients: those with low disease activity (CDAI score less than 10), and those with moderate to high disease activity (CDAI score greater than 10). Intervention: Patients meeting inclusion criteria will be enrolled and assessed at baseline and every 3 months for 12 months, for a total of 5 assessments. Patients will receive our modified T2T approach, which will add PROMIS measures of pain, fatigue, depression and physical function to our standard CDAI and RAPID3 assessments. Patients will also participate in a semi-structured baseline interview to identify outcomes most important to them. Evaluation: We will evaluate the degree of adoption of a patient portal integrated into the (Epic) electronic health record (EHR), assessing scoring and reporting PRO scores on both RAPID3 and PROMIS; Northwestern rheumatologists’ attitudes toward the use of PROs in clinical practice at the conclusion of the this program; patient satisfaction with their care at the conclusion of their one-year participation in the program, improvement in pain, fatigue, depression and physical function as measured by PROMIS; and comparison of outcomes in this cohort to those of the cohort in the CORRONA T2T study.