Abstract

Objective

To examine the clinic 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 collected Organizational Readiness to Implement Change (ORIC), and Team Learning and Psychological Safety Survey (TLPSS) at baseline. The primary study outcome objective measure was penetration/reach at the end-of-study (=enrolled*100/eligible SLE patients). We used validated clinic personnel surveys to examine perceived lupus PtDA appropriateness, acceptability, feasibility, success, and permanence, at 4-, 12- and 24-months post-PtDA implementation.

Results

Clinic personnels’ (n = 184) baseline ORIC commitment and efficacy scores (a 0–5 scale, higher=better) ranged from 3.5–4.2, and 3.4–4.4 for the sites, respectively; 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. Penetration (primary outcome) among 15 geographically diverse U.S. rheumatology clinics ranged 3% to 44%. We found that the total number of providers in the clinic was positively associated with higher penetration. Clinic personnel perceived lupus PtDA outcomes were optimal at 4-months (all scale score ranged 1–5, higher=better): (1) appropriateness, 3.43 (SD, 0.86); (2) acceptability, 3.53 (SD, 0.83); (3) feasibility, 3.44 (SD, 0.71); (4) success, 3.41 (SD, 0.73); and (5) permanence, 3.22 (SD, 0.74).

Conclusions

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

Trial Registration

ClinicalTrials.gov, NCT03735238

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