This K23 Mentored Patient-Oriented Research Award will provide additional training and practical experience for the candidate, Dr. Jennifer Barton. Dr. Barton is a rheumatologist who practices at a public hospital and has developed a research agenda around patient-clinician communication and health disparities. To further develop her career and achieve the goals of her research plan, Dr. Barton requires additional training in three areas: 1) qualitative research methods, 2) collaboration with measurement experts, health IT, and communication experts in development of a patient-reported tool, and 3) advanced biostatistical methods. Dr. Barton has assembled a multidisciplinary team to assure her success in achieving the goals of this award. Specifically, her primary mentor Dr. Edward Yelin, an expert in health services research in the rheumatic diseases, and co-mentor, Dr. Dean Schillinger, an internationally recognized expert in health communication with extensive expertise in implementing interventions among vulnerable populations, are uniquely situated to oversee Dr. Barton's training plan and execution of the research strategy. Dr. Patricia Katz, an expert in measurement science at UCSF; Dr. Victor Montori, a Mayo Clinic investigator and expert in the design of tools to share knowledge in the clinical encounter; Dr. Liana Fraenkel, a rheumatologist and health services researcher with extensive experience in patient preference and decision making; Dr. Somnath Saha, OHSU researcher in health communication and racial disparities in chronic disease; and Dr. Stuart Gansky, a UCSF biostatistician with experience analyzing data from observational studies of diverse populations, will provide support, expertise, and unique perspectives to Dr. Barton. Despite advances in treatment options and strategies for rheumatoid arthritis, significant disparities in outcomes among ethnic minorities and non-English speakers persist. Effective patient-clinician communication is central to the diagnosis, appropriate treatment, and avoidance of unsafe use or misuse of costly, potentially toxic therapies. Despite the need for a trusting partnership between patient and doctor to manage RA, goal- setting remains an unexplored domain, especially among patients who face barriers to communication. Therefore, in Aim 1, Dr. Barton will develop a measure of patient-clinician goal concordance; assess the extent and predictors of goal concordance using a mixed methods approach.
In Aim 2, Dr. Barton will evaluate whether goal concordance is associated with trust, RA self-efficacy, quality of life, and medication adherence.
In Aim 3, she will develop and pilot-test an intervention to enhance the elicitation of patient goals and conduct a larger, randomized trial of the intervention. This project will deepen our understanding of goal concordance in RA, as well as provide necessary training and practical experience to ensure Dr. Barton's success as an independent clinical investigator, and provide the basis of an RO1-application to evaluate an intervention to improve patient-clinician communication and quality of care in RA.

Public Health Relevance

Significant disparities in outcomes among ethnic minorities and non-English speakers with rheumatoid arthritis (RA) persist despite significant advances in therapy and treatment strategies. One potential mechanism for these disparities is suboptimal communication around goals for therapy. We will evaluate the degree and impact of goal concordance on outcomes in RA, and develop and test the effectiveness and feasibility of an intervention to improve communication among vulnerable populations with RA and their clinicians.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Mentored Patient-Oriented Research Career Development Award (K23)
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Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
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Serrate-Sztein, Susana
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Oregon Health and Science University
Schools of Medicine
United States
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Barton, Jennifer L; Hulen, Elizabeth; Schue, Allison et al. (2018) Experience and Context Shape Patient and Clinician Goals For Treatment of Rheumatoid Arthritis: A Qualitative Study. Arthritis Care Res (Hoboken) 70:1614-1620
Ratanawongsa, Neda; Matta, George Y; Lyles, Courtney R et al. (2017) Multitasking and Silent Electronic Health Record Use in Ambulatory Visits. JAMA Intern Med 177:1382-1385
Schwab, Pascale; Sayles, Harlan; Bergman, Debra et al. (2017) Utilization of Care Outside the Veterans Affairs Health Care System by US Veterans With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 69:776-782
Liew, Jean; Lucas Williams, J; Dobscha, Steven et al. (2017) Posttraumatic stress disorder and correlates of disease activity among veterans with ankylosing spondylitis. Rheumatol Int 37:1765-1769
Hulen, Elizabeth; Ervin, Ayla; Schue, Allison et al. (2017) Patient goals in rheumatoid arthritis care: A systematic review and qualitative synthesis. Musculoskeletal Care 15:295-303
Toupin-April, Karine; Barton, Jennifer; Fraenkel, Liana et al. (2017) Toward the Development of a Core Set of Outcome Domains to Assess Shared Decision-making Interventions in Rheumatology: Results from an OMERACT Delphi Survey and Consensus Meeting. J Rheumatol 44:1544-1550
Trenaman, Logan; Boonen, Annelies; Guillemin, Francis et al. (2017) OMERACT Quality-adjusted Life-years (QALY) Working Group: Do Current QALY Measures Capture What Matters to Patients? J Rheumatol 44:1899-1903
Petkovic, Jennifer; Barton, Jennifer L; Flurey, Caroline et al. (2017) Health Equity Considerations for Developing and Reporting Patient-reported Outcomes in Clinical Trials: A Report from the OMERACT Equity Special Interest Group. J Rheumatol 44:1727-1733
Ratanawongsa, Neda; Barton, Jennifer L; Lyles, Courtney R et al. (2017) Computer use, language, and literacy in safety net clinic communication. J Am Med Inform Assoc 24:106-112
Barton, Jennifer L; Trupin, Laura; Schillinger, Dean et al. (2016) Use of Low-Literacy Decision Aid to Enhance Knowledge and Reduce Decisional Conflict Among a Diverse Population of Adults With Rheumatoid Arthritis: Results of a Pilot Study. Arthritis Care Res (Hoboken) 68:889-98

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