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
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.
M.E. Ryan, DO, D. Bullock, MD, University of Minnesota, Minneapolis, Minnesota, USA.
J Rheumatol. 2022 May;49(5):497-503. doi: 10.3899/jrheum.210709. Epub 2022 Feb 1.
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.
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.
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.
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.
治疗达标（T2T）是一种调整治疗直至达到目标的策略。一个国际特别工作组推荐将T2T用于青少年特发性关节炎（JIA）的治疗。要在临床实践中以标准且可靠的方式实施T2T，需要就以下关键要素达成一致：（1）目标设定；（2）T2T策略；（3）识别实施障碍；（4）患者资格。儿科风湿病护理与结局改善网络（PR - COIN）的利益相关者召开了一次共识会议，以形成一份关于PR - COIN的T2T方法的理解声明。
邀请包括16名医疗服务提供者和4名家长在内的PR - COIN利益相关者组成一个投票小组。采用名义群体技术，进行两轮投票以解决上述4个领域的问题，按排名选出前10项回应。
在设定治疗目标时，纳入患者目标被认为最为重要。共同决策（SDM）、跟踪可测量的结局以及调整治疗以实现目标被选为T2T策略的首要要素。工作流程考量和提供者的支持被确定为T2T实施的关键障碍。具有不良预后因素且有高疾病负担风险的JIA患者是T2T方法的主要适用对象。
本次共识会议确定了将患者目标纳入目标设定的重要性，以及患者利益相关者参与制定治疗建议的影响。T2T的网络方法将进行修改以应对上述发现，包括征求患者目标、优化共同决策以及更好地整合工作流程。
