March 20, 2017 | Erin Bluvas, bluvase@sc.edu
Melanie Cozad, an assistant professor in the Department of Health Services Policy and Management (HSPM) and the South Carolina SmartState Center for Effectiveness Research in Orthopaedics (CERortho), has received a $289,576 Independent Grant for Learning and Change from the biopharmaceutical company, Pfizer. Working in close collaboration with Gulzar Merchant, a rheumatologist with the Greenville Health System, the funding will support the project, Integrating a Personalized Patient-Specific Preference Tool to Enhance Shared Decision Making for Rheumatoid Arthritis Patients.
Through the project, rheumatologists and patients will gain guidance that facilitates better communication during the course of an office visit in order to achieve patient-centered care (i.e., care that meets the patient’s priorities and goals for treatment and fits with the patient’s lifestyle). Working with the rheumatoid arthritis population within the Greenville Health System where CERortho is located, Cozad and her team* will develop a survey instrument to measure each patient’s individual lifestyle factors and priorities (e.g., pain reduction, fatigue management, mobility). Capturing this information is critical to achieving patient-centered care. To integrate a patient’s priorities into the care process, a patient will use an app-like program to enter his/her goals for treatment into an iPAD or computer that then converts those priorities into a pictograph.
The patient receives the pictogram along with information on how to discuss his/her most important goals with his/her rheumatologist. The patient’s rheumatologist, who will have access to the pictograph in the exam room, will be able to discuss the treatment options available to the patient in terms of the patient’s priorities. The information on priorities becomes part of the patient’s medical record.
“For conditions such as rheumatoid arthritis, where a cure is not possible, it is imperative that the care provided meets with the patient’s goals. This approach incorporates a more holistic understanding of how an individual’s lifestyle and priorities affect treatment decisions that, in turn, determine more successful management of the disease,” explains Cozad. “There are currently no support tools that help the patient express goals to the rheumatologist during the care process.”
The development of this data collection tool and its integration into clinical care holds the potential to achieve care that is of greater value to patients. By helping patients be an active participant in the discussion with their health care provider about the treatment options that are “right” for them, Cozad and her team hope to improve communication as well treatment adherence.
“Facilitating this communication is especially important for rheumatoid arthritis patients because many new treatment alternatives have become available over the past few years,” says Cozad. “These treatment options often have differential effects on pain control, mobility, fatigue, joint deformity management, and other treatment effects, but there is currently little support to help rheumatoid arthritis patients think about the trade-offs across these outcomes that different treatment options might require. For example, a patient who is concerned with preserving her fertility may choose a different treatment than a patient who is focused on achieving pain control.”
The project will initially target recently diagnosed patients, as this population has been shown to be overwhelmed by the vast amount of information that must be considered in order to make treatment decisions. Long-term, the team hopes the support tool can be adapted to work more broadly for all rheumatiod arthritis patients and applied to other chronic dieseases.
Cozad was able to secure the Pfizer grant, in part, due to a $14,890 Advanced Support for Innovative Research Excellence (ASPIRE) grant she received from the USC Office of the Vice President for Research to study preference measurement methods. Though the ASPIRE-funded research is still ongoing, the preliminary results from this project played a major role in the formation of her Pfizer grant application.
*Primary collaborators include:
| Collaborator | Role |
|---|---|
| Melanie Cozad, Ph.D. | Principal Investigator |
| Gulzar Merchant, MD | Clinical Investigator Research Partner |
| Mark Macauda, Ph.D. | Co-Investigator |
| Jan Ostermann, Ph.D. | Co-Investigator |
| Cole Chapman, Ph.D. | Co-Investigator |
| Peggy Wagner, Ph.D. | Studio Director, GHS Patient Engagement Studio |