FEASIBILITY AND USABILITY OF A CLINICAL DECISION SUPPORT SYSTEM FOR TREAT-TO-TARGET IN SYSTEMIC LUPUS ERYTHEMATOSUS: THE T2T-SLE PILOT STUDY

PT015 / #768 Topic: AS24 - SLE-Treatment POSTER TOUR 03: RECENT ADVANCEMENTS IN SLE CLINICAL OUTCOMES AND THERAPY 23-05-2025 10:00 AM - 10:40 AM Background/Purpose The Treat-to-Target (T2T) strategy has been endorsed for systemic lupus erythematosus (SLE) management, yet its implementation remains challenging.[1] A clinical decision support system (CDSS) was developed to assist physicians in applying a T2T approach in clinical practice.[2] This study aimed to assess the feasibility, usability, and acceptability of a CDSS designed to implement a T2T strategy in SLE management from the perspectives of both physicians and patients. Methods The T2T-SLE study was a 24-week, nonrandomized, cluster, multicenter pilot study conducted in North Holland, including 2 tertiary university medical centers (UMCs) and 2 regional outpatient clinics. Patients diagnosed with SLE were assigned by treatment center to either routine care or T2T-CDSS-assisted care. The CDSS, developed based on evidence-based guidelines, provided clinical recommendations for disease management. Primary outcomes included feasibility (recruitment, retention, and implementation challenges), usability (physicians perceived ease of use of the CDSS web-app), and acceptability (physician and patient satisfaction). The CDSS was evaluated solely by physicians, with 1 physician in an UMC and 1 in a regional center using the tool. In turn, patients reported their satisfaction with the T2T strategy, which involved more frequent outpatient clinic visits and structured discussions on treatment targets. Patient feedback was collected through qualitative questionnaires and patient-reported outcome measures (PROMs). Secondary outcomes included treatment patterns, disease activity measures, and implementation barriers and facilitators. Results A total of 91 participants were screened, with 38 enrolled (41.8%) and 35 completing the study (92.1% retention). The most common reason for declining participation was unspecified reasons (24.7%) followed by lack of interest (23.1%) and scheduling conflicts due to life events (4.4%) (Figure 1). The enrolled population was representative of a broad spectrum of SLE severity, with a mix of stable and active disease. Patients in the T2T-CDSS group had slightly lower baseline disease activity scores compared to the routine care group, though both groups exhibited similar demographic characteristics (Table 1). Physicians reported that the CDSS was useful in supporting T2T-based decision-making, but challenges related to workflow integration and time constraints were noted. Patients in the T2T group generally expressed satisfaction with the strategy, highlighting the benefits of increased monitoring and shared treatment goal discussions. However, some reported concerns about the burden of more frequent visits. Fig 1. Enrollment Diagram, Inclusion and Exclusion Criteria Table 1. Baseline characteristics in patients from the treat-to-target and the routine care group Conclusions The T2T-SLE pilot study demonstrated the feasibility of using a CDSS to implement a T2T strategy in SLE management. Physician-reported usability was positive, though workflow integration challenges were noted. Patients valued structured treatment discussions but reported mixed opinions on visit frequency. The study demonstrated feasibility for larger-scale implementation, though recruitment delays and engagement challenges indicate a need for improved patient outreach strategies. Future studies should optimize recruitment strategies and further assess long-term clinical effectiveness. References: [1.] Parra Sanchez AR. Nat Rev Rheumatol 2022;18(3):146-57. [2.] Parra Sanchez AR. BMJ Health Care Inform 2023;30(1):e100811.