背景:国际皮肤病学结果测量和美国皮肤病学会最近就医师报告的全球严重程度测量达成一致,以证明炎症性皮肤病的护理质量。
目的:因为患者报告的结果指标也很重要,我们的目标是在临床实践中就其中1项措施达成共识.
方法:患者和提供者参与了一项涉及改良Delphi技术的共识建立研究。投票的重点是确定一套最低限度的临床实践评估,患者全球评估(PtGA),Skindex仪器,和最终的仪器选择质量改进。
结果:在53个利益相关者中,>70%的人同意确定患者的目标,治疗危害评估,和评估治疗反应的充分性是临床实践所需的最低限度评估.最优选的PtGA是5点PtGA(量表0-4;0=清晰,4=严重)有一个可选的复选框,有史以来最糟糕的。一种新的指标来评估自治疗开始以来的变化,我们称之为轨迹测量,被提议了。利益相关者更喜欢Skindex仪器而不是PtGA,并且是临床实践的轨迹度量。
结论:涉及少数患者和护理人员,未在所有项目上达成共识。
结论:PtGA作为独立的措施不能充分掌握患者对疾病严重程度或护理效果的评估。PtGA与Skindex仪器或另一种与健康相关的生活质量的测量相结合,可能会在临床实践中对患者进行更全面的评估。
International Dermatology Outcome Measures and the American Academy of Dermatology recently agreed on a physician-reported global severity measure to demonstrate quality of care in inflammatory dermatoses.
Because patient-reported outcome measures are also important, we aimed to achieve
consensus on 1 of these measures for clinical practice.
Patients and providers participated in a
consensus-building study involving a modified-Delphi technique. Voting was focused on identifying a minimal set of assessments for clinical practice, patient global assessments (PtGAs), Skindex instruments, and final instrument selection for quality improvement.
Among 53 stakeholders, >70% agreed that identification of patient goals, assessment of treatment harm, and assessment of the adequacy of treatment response were the minimal assessments needed for clinical practice. The most preferred PtGA was a 5-point PtGA (scale 0-4; 0 = clear, 4 = severe) having an optional check-box for worst ever. A new metric to assess change since treatment initiation, which we called a trajectory measure, was proposed. Stakeholders preferred Skindex instruments over PtGAs and a trajectory measure for clinical practice.
A small number of patients and caregivers were involved and a
consensus was not reached on all items.
PtGAs as standalone measures do not adequately capture the patient\'s assessment of disease severity or the effect of care. The combination of a PtGA with a Skindex instrument or another measure of health-related quality of life might provide a more comprehensive evaluation of patients in clinical practice.