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Consensus Approach to a Treat-to-target Strategy in Juvenile Idiopathic Arthritis Care: Report From the 2020 PR-COIN Consensus Conference.
El Tal, Tala; Ryan, Meghan E; Feldman, Brian M; Bingham, Catherine April; Burnham, Jon M; Batthish, Michelle; Bullock, Danielle; Ferraro, Kerry; Gilbert, Mileka; Gillispie-Taylor, Miriah; Gottlieb, Beth; Harris, Julia G; Hazen, Melissa; Laxer, Ronald M; Lee, Tzielan Chang; Lovell, Daniel; Mannion, Melissa; Noonan, Laura; Oberle, Edward; Taylor, Janalee; Weiss, Jennifer E; Toruner, Cagri Yildirim; Morgan, Esi M.
Afiliación
  • El Tal T; 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.
  • Ryan ME; M.E. Ryan, DO, D. Bullock, MD, University of Minnesota, Minneapolis, Minnesota, USA.
  • Feldman BM; 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.
  • Bingham CA; C.A. Bingham, MD, Penn State Children's Hospital, Hershey, Pennsylvania, USA.
  • Burnham JM; J.M. Burnham, MD, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
  • Batthish M; M. Batthish, MD, McMaster University, Hamilton, Ontario, Canada.
  • Bullock D; M.E. Ryan, DO, D. Bullock, MD, University of Minnesota, Minneapolis, Minnesota, USA.
  • Gilbert M; M. Gilbert, MD, Medical University of South Carolina, Charleston, South Carolina, USA.
  • Gillispie-Taylor M; M. Gillispie-Taylor, MD, C. Yildirim Toruner, MD, Texas Children's Hospital Baylor College of Medicine, Houston, Texas, USA.
  • Gottlieb B; B. Gottlieb, MD, Cohen Children's Medical Center, Lake Success, New York, USA.
  • Harris JG; J.G. Harris, MD, Children's Mercy Kansas City, Kansas City, Kansas, USA.
  • Hazen M; M. Hazen, MD, Boston Children's Hospital, Boston, Massachusetts, USA.
  • Laxer RM; 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.
  • Lee TC; T.C. Lee, MD, Stanford Children's Health, Palo Alto, California, USA.
  • Lovell D; D. Lovell, MD, J. Taylor, CNP, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
  • Mannion M; M. Mannion, MD, University of Alabama at Birmingham, Birmingham, Alabama, USA.
  • Noonan L; L. Noonan, MD, Levine Children's Hospital/Carolinas Healthcare System, Charlotte, North Carolina, USA.
  • Oberle E; E. Oberle, MD, Nationwide Children's Hospital, Columbus, Ohio, USA.
  • Taylor J; D. Lovell, MD, J. Taylor, CNP, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
  • Weiss JE; J.E. Weiss, MD, Hackensack University Medical Center, Hackensack, Hackensack, New Jersey, USA.
  • Toruner CY; M. Gillispie-Taylor, MD, C. Yildirim Toruner, MD, Texas Children's Hospital Baylor College of Medicine, Houston, Texas, USA.
  • Morgan EM; E.M. Morgan, MD, MSCE, University of Washington, and Seattle Children's Hospital, Seattle, Washington, USA.
J Rheumatol ; 49(5): 497-503, 2022 05.
Article en En | MEDLINE | ID: mdl-35105705
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Artritis Juvenil / Reumatología Tipo de estudio: Guideline / Prognostic_studies Aspecto: Patient_preference Límite: Child / Humans Idioma: En Revista: J Rheumatol Año: 2022 Tipo del documento: Article País de afiliación: Canadá
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Artritis Juvenil / Reumatología Tipo de estudio: Guideline / Prognostic_studies Aspecto: Patient_preference Límite: Child / Humans Idioma: En Revista: J Rheumatol Año: 2022 Tipo del documento: Article País de afiliación: Canadá