Saving time and improving care with a multidimensional health assessment questionnaire: 10 practical considerations T Pincus, Y Yazici, M Bergman J Rheumatol.

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Presentation transcript:

Saving time and improving care with a multidimensional health assessment questionnaire: 10 practical considerations T Pincus, Y Yazici, M Bergman J Rheumatol 2006;33:448.

Patient questionnaires in clinical research vs clinical care J Rheumatol 2000;27:2727. Clinical researchClinical care —Complete, long —Takes time from care —Complex scoring —Results unknown in care —Send to data center —Enter into computer —Patient friendly, <10 min —Saves time for MD —“Eyeball” results —Adds to clinical care —Review with patient —Enter into flowsheet: —Add to care —Documentation

The MDHAQ in clinical rheumatology In rheumatoid arthritis, the MDHAQ distinguishes MTX or LEF from placebo in a clinical trial as effectively as a joint count or the ACR 20. In osteoarthritis, the MDHAQ distinguishes NSAID from acetaminophen as effectively as the WOMAC. In fibromyalgia, the MDHAQ distinguishes patients from those with rheumatoid arthritis as effectively as an ESR.

HAQ and multidimensional HAQ (MDHAQ) HAQMDHAQ Latest report # ADL2010 Pain VAS10-cm line21 circles Pt Global VAS10-cm line21 circles FatigueNo21 circle VAS PsychNo3-HAQ format DrugsNoList Review of systemsNo60 Sx Past historyNo Yes DemographicsNo Yes Social historyNoYes Scoring templates NoYes Patient completion 5-10 min5-10 min MD scan (“eyeball”) 30 secs5 secs Time to score>1 min<20 secs

RA; 35-year-old female (#13) Onset: 02/2003 Visit 10 Visit date 3/5/033/11/033/25/035/20/038/19/031/24/06 Function (0-10) Pain (0-10) Global (0-10) ESR Prednisone N-10qdC-5bidT-5qd5qdC-4qd4qd Methotrexate N15qw15qw C20qw20qw Etanercept n25biw25biw 50qw Folic acid N-1qd1qd Ibuprofen 200prn Hydrocodone 1q6h D/C N = new drug, C = change in dose T = taper, D/C = discontinue

Quantitative monitoring of RA over 720 days: MHAQ, pain Pincus T. Arthritis Care Res. 1996;9:339. Salsalate Zero Order Aspirin Fenoprofen Piroxicam Methotrexate Auranofin Injectable gold Prednisone Visual analog Pain scale MHAQ Difficulty score /871/885/889/881/895/898/89

Pincus et al. New Engl J Med. 1969;281:701. Quantitative monitoring of a patient with SLE over 180 days: ESR, anti-DNA, CH50 Creatine clearance (mL/min) LE prep CH 50 Prednisone (mg/day) % DNA bound ESR (mm/hr) Days

Over the last six months have you had: NYNY An operation?Change in drugs? Inpatient hospitalization?Change of address? New illness or accident?Change in marital status? New symptoms?Job change? Drug side effects?Insurance change? Smoked cigarettes?Physician change? Please explain any “Yes” answer below, or indicate any other health matter that affects you: __________________________________________________ ________________________________________________________

Among all available clinical measures in patients with rheumatoid arthritis, a patient questionnaire, not X-ray or lab test, is the BEST predictor of… Functional status (Pincus et al. Arthritis Rheum. 1984;27:864., Wolfe et al. J Rheumatol. 1991;18:1298.) Work disability (Callahan et al. J Clin Epidemiol. 1992;45:127., Wolfe and Hawley. J Rheumatol. 1998;25:2108.) Costs (Lubeck et al. Arthritis Rheum. 1986;29:488.) Death (Pincus et al. Arthritis Rheum. 1984;27:864.; Ann Intern Med.1994;120:26., Wolfe et al. Arthritis Rheum. 1994;37:481.)

“The proper study of mankind is man.” Alexander Pope, 1733