Dr. Barton’s research focuses on the role of patient-clinician communication in quality of care and health disparities among patients with rheumatic disease. Dr. Barton and colleagues have studied communication barriers such as limited health literacy and English language proficiency and their impact on patient-clinician communication, shared decision-making, and goal concordance. Through funding from the Rheumatology Research Foundation, National Institutes of Health, VA HSRD, and other support, Dr. Barton and the team have worked to create and implement tools and interventions to enhance patient engagement and communication, facilitate shared decision-making, and with the goal to improve health outcomes and reduce disparities for persons with rheumatic disease. A summary of previous research projects and links to key publications are listed here. Feel free to contact Dr. Barton directly at bartoje@ohsu.edu.
Goal Concordance in Rheumatoid Arthritis (GoRA)
In this 5-year NIH-funded career development award, GoRA aimed to better understand rheumatoid arthritis (RA) patient goals for therapy, whether those goals correspond with those of clinicians, whether concordance is associated with RA outcomes, and how best to intervene to improve communication. Through focus groups, we found that knowledge is a shared goal, but RA patients and clinicians hold divergent attitudes toward this goal. While knowledge is integral to self-management and effective shared decision-making, mismatches in attitudes may lead to suboptimal communication. Through the survey study, we found that one in five patient-clinician dyads were discordant (unaligned) around RA treatment goals. Patients with longer RA disease duration were more likely to be discordant with their clinician. This may highlight shifting goals over time for patients (more focus on function and mood with longer duration). Goal concordance was independently associated with higher adherence, which suggests that clearer communication around treatment goals may lead to improved adherence and outcomes. These findings suggest that tools to support patient goal-directed RA care may promote high-quality patient-centered care and result in reduced disparities.
Publications related to Goal Concordance in Rheumatoid Arthritis (GoRA)
Patient goals in rheumatoid arthritis care: A systematic review and qualitative synthesis.
Quality of care among US veterans with rheumatoid arthritis
The Quality of Care study objective was to determine the proportion of Veterans with RA nationwide receiving care in VA who were prescribed a disease-modifying anti-rheumatic drug (DMARD) annually over the past decade and, for 2017, to identify Veteran- and system-level correlates of DMARD receipt. Using administrative health data, we determined the annual proportion of Veterans with RA who received a DMARD increased from a rate of 76% in 2006 to 85.6% in 2017. Additional factors such as female sex, age >80, substance use disorder, Rheumatology shortage area, lower facility level complexity, and residing in the Southeast region were associated with lower rates of DMARD receipt.
In a separate nationwide survey study, VA rheumatology clinicians reported suboptimal experience and satisfaction with telerheumatology. Clinicians agreed that telehealth is essential to increasing access to care and indicated that telerheumatology is most useful for managing, as opposed to diagnosing, rheumatologic conditions but inability to perform a physical exam, the training of presenters at the patient sites, and phase of care were all identified as barriers.
Publications related to Quality of care among US veterans with rheumatoid arthritis
RA Choice is low literacy, multilingual medication summary guide and decision aid tool for RA patients and clinicians developed by a multi-stakeholder team including Dr. Barton. This tool was designed to facilitate shared decision-making – when patients and clinicians work together to identify how to best address the patient’s situation. Past research has shown the tool improves patient knowledge and decision quality, but it has not been tested broadly. To keep pace with recent therapeutic advances and most effectively support shared decision-making for all RA patients, RA Choice 2.0 aimed to update and digitize the RA medication summary guide and decision aid; and to evaluate the acceptability and feasibility of use of the updated, print, and digital medication summary guide and RA Choice among persons with RA and their clinicians.
Publications related to RA Choice 2.0
Barton Lab 