Implementation Outcomes of a Patient Decision-Aid in a Diverse Population With Systemic Lupus Erythematosus in 15 Us Rheumatology Clinics

Authors

Jasvinder A Singh
Larry R Hearld
Seth Eisen
W Winn Chatham
Sonali Narain
Narender Annapureddy
Diane L Kamen
Kimberly Trotter
Vikas Majithia
Cathy Lee Ching
Zineb Aouhab
Swamy Venuturupalli
Daniel J Wallace
Rosalind Ramsey-Goldman
Alfred Kim
Maureen McMahon
S Sam Lim
Kalpana Bhairavarasu
Alexa Meara
Kenneth Kalunian
T Mark Beasley

Language

English

Publication Date

8-1-2025

Journal

Rheumatology

DOI

10.1093/rheumatology/keaf205

PMID

40221856

PMCID

PMC12316375

PubMedCentral® Posted Date

4-12-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Objective: The objective of this study was to examine the clinical outcomes during the implementation of a self-administered patient decision-aid (PtDA) for lupus.

Methods: We provided an effective computerized lupus PtDA in 15 rheumatology outpatient clinics 2019-2024 (including the COVID pandemic). We undertook Organizational Readiness to Implement Change Surveys (ORICs) and Team Learning and Psychological Safety Surveys (TLPSSs) at baseline. The primary study outcome objective measure, percent penetration/reach, was defined as the number of patients who viewed the lupus PtDA at the end of the study, divided by the total number of eligible patients (times 100). We used validated clinical personnel surveys to examine the perceived lupus PtDA appropriateness, acceptability, feasibility, success, and permanence, at 4 months, 12 months and 24 months post-PtDA implementation.

Results: Among the sites, the clinical personnels' (n = 184) baseline ORIC commitment and efficacy scores (a 0-5 scale, higher = better) ranged from 3.5 to 4.2, and 3.4 to 4.4, respectively; the TLPSS scores (a 0-7 scale, higher = better) were 3.9-5.5 for internal learning, 3.7-5.6 for external learning, and 4.3-5.5 for psychological safety. The penetration (primary outcome) among 15 geographically diverse US rheumatology clinics ranged from 3% to 44%. We found that the total number of providers in the clinic was positively associated with higher penetration. Clinical personnel-perceived lupus PtDA outcomes were optimal at 4 months (all scale scores ranged from 1 to 5, higher = better): (i) appropriateness, 3.43 (s.d. 0.86); (ii) acceptability, 3.53 (s.d. 0.83); (iii) feasibility, 3.44 (s.d. 0.71); (iv) success, 3.41 (s.d. 0.73); and (v) permanence, 3.22 (s.d. 0.74).

Conclusion: We implemented a lupus PtDA with varied success rates during the COVID pandemic; more providers were associated with higher clinic penetration. Clinical personnel perceived high lupus PtDA appropriateness, acceptability, feasibility, success, and permanence that persisted up to 24 months.

Trial registration: ClinicalTrials.gov, http://clinicaltrials.gov, NCT03735238.

Keywords

Humans, Lupus Erythematosus, Systemic, Female, Male, Rheumatology, Middle Aged, COVID-19, Adult, United States, Decision Support Techniques, Patient Participation, SARS-CoV-2, Ambulatory Care Facilities, implementation, decision-aid, systemic lupus erythematosus, rheumatology clinic, clinical outcomes, clinical personnel, education, health-care delivery

Published Open-Access

yes

Recommended Citation

Singh, Jasvinder A; Hearld, Larry R; Eisen, Seth; et al., "Implementation Outcomes of a Patient Decision-Aid in a Diverse Population With Systemic Lupus Erythematosus in 15 Us Rheumatology Clinics" (2025). Faculty and Staff Publications. 4085.
https://digitalcommons.library.tmc.edu/baylor_docs/4085