SF 36 health survey questionnaire: II. Responsiveness to changes in health status in four common clinical conditions.

OBJECTIVE--To assess the responsiveness of the SF 36 health survey questionnaire to changes in health status over time for four common clinical conditions. DESIGN--Postal questionnaires at baseline and after one year's follow up, with two reminders at two week intervals if necessary. SETTING--Clinics and four training general practices in Grampian region in the north east of Scotland. PATIENTS--More than 1,700 patients aged 16 to 86 years with one of four conditions: low back pain, menorrhagia, suspected peptic ulcer, and varicose veins; and a random sample of 900 members of the local general population for comparison. MAIN MEASURES--A transition question measuring change in health and the eight scales of the SF 36 health survey questionnaire; standardised response means (mean change in score for a scale divided by the standard deviation of the change in scores) used to quantify the instrument's responsiveness to changes in perceived health status, and comparison of patient scores at baseline and follow up with those of the general population. RESULTS--The response rate exceeded 75% in a patient population. Changes across the SF 36 questionnaire were associated with self reported changes in health, as measured by the transition question. The questionnaire showed significant improvements in health status for all four clinical conditions, whether in referred or non-referred patients. For patients with suspected peptic ulcer and varicose veins the SF 36 profiles at one year approximate to the general population. CONCLUSIONS--These results provide the first evidence of the responsiveness of the SF 36 questionnaire to changes in perceived health status in a patient population in the United Kingdom.     

SF 36 health survey questionnaire: I. Reliability in two patient based studies.

OBJECTIVE--To assess the reliability of the SF 36 health survey questionnaire in two patient populations. DESIGN--Postal questionnaire followed up, if necessary, by two reminders at two week intervals. Retest questionnaires were administered postally at two weeks in the first study and at one week in the second study. SETTING--Outpatient clinics and four training general practices in Grampian region in the north east of Scotland (study 1); a gastroenterology outpatient clinic in Aberdeen Royal Hospitals Trust (study 2). PATIENTS--1787 patients presenting with one of four conditions: low back pain, menorrhagia, suspected peptic ulcer, and varicose veins and identified between March and June 1991 (study 1) and 573 patients attending a gastroenterology clinic in April 1993. MAIN MEASURES--Assessment of internal consistency reliability with Cronbach's alpha coefficient and of test-retest reliability with the Pearson correlation coefficient and confidence interval analysis. RESULTS--In study 1, 1317 of 1746 (75.4%) correctly identified patients entered the study and in study 2, 549 of 573 (95.8%). Both methods of assessing reliability produced similar results for most of the SF 36 scales. The most conservative estimates of reliability gave 95% confidence intervals for an individual patient's score difference ranging from -19 to 19 for the scales measuring physical functioning and general health perceptions, to -65.7 to 65.7 for the scale measuring role limitations attributable to emotional problems. In a controlled clinical trial with sample sizes of 65 patients in each group, statistically significant differences of 20 points can be detected on all eight SF 36 scales. CONCLUSIONS--All eight scales of the SF 36 questionnaire show high reliability when used to monitor health in groups of patients, and at least four scales possess adequate reliability for use in managing individual patients. Further studies are required to test the feasibility of implementing the SF 36 and other outcome measures in routine clinical practice within the health service.     

Clinical priority criteria in orthopaedics: a validation study using the SF36 quality of life questionnaire.

This study reports a validation trial of a clinical priority scoring tool in orthopaedic surgery based on five dimensions related to need and ability to benefit using the SF36 health related quality of life questionnaire. Seventy patients attending an orthopaedic outpatient clinic were asked to complete the questionnaire before being seen by an orthopaedic specialist. Their clinical priority for surgery was scored using a tool which assesses five dimensions of clinical need with a maximum of 100 points. Our study has shown that the clinical priority scores correlate very well with the quality of life of patients and that those who were selected for surgery had a significantly worse quality of life compared to those not qualifying for surgery due to the lack of financial resources. Although this study has limits, it should provide sufficient information to healthcare clinicians and managers that this tool will select those patients who have the highest need and ability to benefit from surgery.     

A compliance and satisfaction with home exercise: a comparison of computer-assisted video instruction and routine rehabilitation practice

Computerized educational technology, in various forms, is permeating the health care setting, and clinicians and program managers are charged with evaluating its potential to improve patient health outcomes. The purpose of this randomized controlled trial was to compare two alternative methods of therapeutic exercise instruction in a sample of orthopedic rehabilitation patients (n = 40). The traditional (control) group received routine inpatient rehabilitation exercise education from physical therapists (using demonstrations, verbal feedback, and written materials), and the technology (intervention) group received routine care as described plus one additional therapeutic session in which a customized set of exercises was downloaded from a computerized database to videotape by each patient's therapist and given to the patient for continued use at home. Data on patient compliance and patient satisfaction were collected at patient discharge and at four-week follow-up using a questionnaire designed specifically for this study. Analysis of results showed no significant differences in patient compliance or patient satisfaction between the two study groups. Results of this randomized trial suggest that computerized patient education technology may not provide the benefits anticipated.     

Should General Practitioners Issue a Sick Certificate to Employees Who Consult for Low Back Pain in Primary Care?

Purpose Back pain is a common problem and has significant societal impact. Sickness certification is commonly issued to patients consulting their general practitioner with low back pain. The aim of this study was to investigate the association of certification for low back pain with clinical outcomes and cost consequences. Methods A prospective cohort study using linked questionnaire and medical record data from 806 low back pain patients in 8 UK general practices: comparison of 116 (14.4 %) who received a sickness certificate versus 690 who did not receive certification. The primary clinical measure was the Roland and Morris Disability Questionnaire (RMDQ). Data on back pain consultation and work absenteeism were used to calculate healthcare and societal costs. Results Participants issued a sickness certificate had higher back-related disability at baseline consultation and 6-month follow-up [mean difference 3.1 (95 % CI 1.8, 4.4) on the RMDQ], indicating worse health status. After fully adjusting for baseline differences, most changes in clinical outcomes at 6 months were not significantly different between study groups. Productivity losses were significantly higher for the certification group, with most absence occurring after the expected end of certification; mean difference in costs due to absenteeism over 6 months was £1,956 (95 % CI £941, £3040). Conclusions There was no clear evidence of a difference in clinical outcomes between individuals issued a sickness certificate and those not issued a certification for their back pain. With little overall contrast in clinical outcomes, policy makers and care providers may wish to draw on the likely difference in societal costs alongside issues in ethical and moral care in their consideration of patient care for low back pain.     

Assessing procedural skills in context: Exploring the feasibility of an Integrated Procedural Performance Instrument (IPPI)

BACKGROUND: The assessment of clinical procedural skills has traditionally focused on technical elements alone. However, in real practice, clinicians are expected to be able to integrate technical with communication and other professional skills. We describe an integrated procedural performance instrument (IPPI), where clinicians are assessed on 12 clinical procedures in a simulated clinical setting which combines simulated patients (SPs) with inanimate models or items of medical equipment. Candidates are observed remotely by assessors whose data are fed back to the clinician within 24 hours of the assessment. This paper describes the feasibility of IPPI. RESULTS: A full-scale IPPI and 2 pilot studies with trainee and qualified health care professionals has yielded an extensive data set including 585 scenario evaluations from candidates, 60 from clinical assessors and 31 from simulated patients (SPs). Interview and questionnaire data showed that for the majority of candidates IPPI provided a powerful and valuable learning experience. Realism was rated highly. Remote and real-time assessment worked effectively, although for some procedures limited camera resolution affected observation of fine details. DISCUSSION: IPPI offers an innovative approach to assessing clinical procedural skills. Although resource-intensive, it has the potential to provide insight into individual's performance over a spectrum of clinical scenarios and at no risk to the safety of patients. Additional benefits of IPPI include assessment in real time from experts (allowing remote rating by external examiners) as well as provision of feedback from simulated patients.     

北京市医疗机构传染病报告质量现况分析

目的评估北京市医疗机构传染病报告质量并找到影响报告质量的因素。方法以现场问卷调查、结构式访谈和收集经常性资料的方法收集资料,分析各级各类医疗机构报告质量。结果二级医院的报告质量高于一级医院、乡镇卫生院和三级医院,城区医疗机构报告质量高于郊区,门诊部、住院部报告质量高于化验室;化验室是漏报的主要环节。结论针对不同的信息报告薄弱环节加强督导、培训等措施,进一步促进传染病信息报告质量。     

A short form for clinical assessment of quality of life among hypertensive patients

Recently, medical research studies and clinical trials have included quality-of-life assessments, which measure the biomedical, behavioral, and social dimensions of living as a major therapeutic end point. Monitoring the quality of life in routine clinical practice also has the potential to aid clinicians to evaluate the impact of new therapies on the health status of their patients. However, because quality-of-life assessment techniques are quite lengthy and often require the aid of a trained interviewer, the research format is not practical for the typical clinical setting. This study describes the formulation, construction, and testing of an abbreviated quality-of-life questionnaire suitable for the clinical assessment of hypertensive patients. The initial formulation was based on analyses of data from a large-scale clinical trial (626 hypertensive male patients). Using the data at baseline for this group, items were selected such that the variance, internal consistency, and concurrent validity of the response scales were maintained by a reduced subset of items. The sensitivity of the reduced subsets was evaluated using treatment data and found to be as sensitive to treatment differentials as the original research instrument was. A subsequent field test of 87 volunteer subjects indicated that the new shortened version had the qualities of stable internal consistency and test-retest reliability over two successive trials. The questionnaire was self-administered and required less than 10 minutes to complete. It was given as an adjunct to the history and physical exam.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comorbidity assessments based on patient report: results from the Veterans Health Study

The objective of the study was to develop a self-reported measure of patients' comorbid illnesses that could be readily administered in ambulatory care settings and that would improve assessment of their health-related quality of life and utilization of health services. Data were analyzed from the Veterans Health Study, an observational study of health outcomes in patients receiving Veterans Administration (VA) ambulatory care. Patients who received ambulatory care services in 4 VA outpatient clinics in the greater Boston area between August 1993 and March 1996 were eligible for inclusion. Among the 4137 patients recruited, 2425 participated in the Veterans Health Study, representing a response rate of 59%. Participants were mailed a health-related quality of life questionnaire, the Medical Outcomes Study Short Form Health Survey (SF-36). They were also scheduled for an in-person interview at which time they completed a medical history questionnaire. We developed a comorbidity index (CI) that included 30 self-reported medical conditions (physical CI) and 6 self-reported mental conditions (mental CI). The physical CI and the mental CI were significantly associated with all SF-36 scales and explained 24% and 36%, respectively, of the variance in the physical component summary and the mental component summary of the SF-36. Both indexes were also significant predictors of future outpatient visits and mortality. The CI is an independent predictor of health status, outpatient visits, and mortality. Its use appears to be a practical approach to case-mix adjustment to account for differences in comorbid illnesses in observational studies of the quality of healthcare. It can be administered to large patient populations at relatively low cost. This method may be particularly valuable for clinicians and researchers interested in population-based studies, case-mix adjustment, and clinical trials.     

The Impact of Reimbursement for Non-Face-to-Face Chronic Care Management on Health Utilization Among Patients With Type 2 Diabetes in Louisiana

ObjectivesWe evaluated the impact of reimbursement for non-face-to-face chronic care management (NFFCCM) on healthcare utilization among Medicare beneficiaries with type 2 diabetes in Louisiana.MethodsWe implemented group-based trajectory balancing and propensity score matching to obtain comparable treatment (with NFFCCM) and control (without NFFCCM) groups at baseline. Patients with diabetes with Medicare as their primary payer at baseline were extracted using electronic health records of 3 health systems from Research Action for Health Network, a Clinical Research Network. The study period is from 2013 to early 2020. Our outcomes include general healthcare utilization (outpatient, emergency department, and inpatient encounters) and health utilization related to diabetic complications. We tested each of these outcomes according to multiple treatment definitions and different subgroups.ResultsReceiving any NFFCCM was associated with an increase in outpatient visits of 657 (95% confidence interval [CI] 626-687; P < .001) per 1000 patients per month, a decrease in inpatient admissions of 5 (95% CI 2-7; P < .001) per 1000 patients per month, and a decrease in emergency department visits of 4 (95% CI 1-7; P = .005) per 1000 patients per month after 24-month follow-up from initial NFFCCM encounter. Both complex and noncomplex NFFCCM significantly increased visits to outpatient services and inpatient admissions per month. Receiving NFFCCM has a dose-response association with increasing outpatient visits per month.ConclusionsPatients with diabetes in Louisiana who received NFFCCM had more low-cost primary healthcare and less high-cost healthcare utilization in general. The cost savings of NFFCCM in diabetes management could be further explored in the future.     

重庆市三级甲等医院临床医生健康现状及其影响因素分析

[目的]观察重庆市三级甲等（以下简称“三甲”）医院临床医生身心健康现状及其主要影响因素,为卫生管理部门有效促进医生身心健康提供依据。[方法]采用自编医生健康状况调查问卷,对重庆6家三甲医院的353名临床医生进行抽样调查,并对该问卷中工作负荷、职业危害、保健投资、身心健康状况4个维度的数据进行多元回归分析等。[结果]所调查的医生中,83．29％感觉工作超负荷;90％以上的医生曾遭遇医院暴力危害;半数以上缺乏个人保健;76．20％存在身心疾病;多元回归分析显示年龄、性别、医院暴力、医院防护、个人保健和目前工作状态是影响医生患身心疾病数目的主要因素。[结论]目前重庆三甲医院临床医生的身心疾病患病率较高,应引起卫生管理部门的高度重视,采取有效措施进行预防和干预。     

Application of the general health status questionnaire SF36 to patients with gastrointestinal dysfunction: initial validation and validation as a measure of change

OBJECTIVE: To determine whether the Short Form (SF36) Health Status Survey is a valid measure of health status and health change for patients with irritable bowel syndrome (IBS). METHODS: The SF36 was self-administered by 116 patients with IBS at the commencement and end of a controlled clinical trial. Patients were recruited through two Sydney teaching hospitals and through private gastroenterologists during 1997 and treated with Chinese herbal medicine. RESULTS: The SF36 health concepts demonstrated internal consistency, construct validity and concurrent validity when applied to patients with significant bowel dysfunction. Patient scores on two health scales of the SF36 (bodily pain, general health) correlated significantly with the bowel symptom scores recorded by patients and gastroenterologists at the beginning and end of the trial period. Actively treated patients significantly improved their scores in four out of eight of the health scales of the SF36 and reported overall improvement compared with inactively treated patients. CONCLUSIONS: The SF36 is a valid measure of general health status in IBS patients, is sensitive to the presence of IBS, and is adequately sensitive to gastrointestinal change in IBS patients. IMPLICATIONS: While the SF36 general health measure is used by the Australian Bureau of Statistics and widely overseas, until recently no data have been available on the sensitivity of the SF36 to gastrointestinal dysfunction or numerous other disorders. The SF36 is not only sensitive to the presence of IBS, it also provides a useful adjunct to current methods of evaluating treatment outcomes for IBS, and potentially other disorders.     

Assessing health status and outcomes in a geriatric day hospital

The study objective was to assess the feasibility and usefulness of recommended outcome measures in older people attending a geriatric day hospital for multidisciplinary assessment and rehabilitation. We used the 'Short Form 36' (SF36) questionnaire which had been proposed as a suitable outcome tool for the elderly, as well as standard assessment scales (eg Barthel index). These were administered by interviewers at the start of day hospital attendance and repeated by postal survey three and six months later. Change in overall health status was rated by the clinical team. The study took place in a geriatric day unit based in a support hospital, specialising in assessment and rehabilitation of older people. Participants were older people referred directly from the community, or following an inpatient day, whose assessment indicated a need for multidisciplinary rehabilitation. Stroke and musculo-skeletal disorders were the commonest underlying conditions. There was a high incidence of non-completion on SF36 questions relating to physical and mental function. Subsequent interviews showed that patients found some questions irrelevant. Floor effects were common. In contrast, the standard scales were invariably fully completed. Compared with local population survey data, respondents had low baseline scores on all SF36 dimensions. Differences over time were probably explained by varying methods of administration. In spite of a clinical perception of improved health status during day hospital attendance, both standard and SF36 scores showed overall deterioration. Two conclusions could be drawn from this study. 1. Measures of physical and mental disability and quality of life gave lower results than expected and continued declining over a six month period, even when the clinical team felt that the patient had improved. 2. Administration of SF36 by an interviewer is essential to obtain meaningful results in older people with poor physical health, which should be interpreted with caution. Goal-specific measures may be more useful in this group of patients.     

Outcomes for a Public Hospital Tobacco Cessation Program: The Cook County Health and Hospitals System Experience

The objective of this study is to determine the rate and predictors of sustained smoking cessation for a cohort of smokers exposed to a guideline-based health education program delivered during routine clinical care at an urban public hospital. This is a retrospective analysis of 755 public hospital system patients who had at least two health educator contacts embedded in routine clinical care, with the latter contact 12–18 months after the baseline. The education occurred during visits to primary care, specialty clinics, urgent/episodic care, or during hospitalization. The assessment of smoking status is determined by the health educators as part of their routine assessment and recorded in the program’s database. The primary outcomes are self-reported 12-month sustained smoking cessation at the 12–18 month contact and predictors of cessation. The cohort is predominantly minority smokers (African American 69 % and Latino 15 %) and uninsured (70 %) or on Medicaid (13 %). The sustained cessation rate was 9.3 %. Latino ethnicity, smoking 1–9 cigarettes/day at baseline, reporting smoke-free home, and additional educator contact in the year after the baseline were independent predictors of sustained cessation in the multivariate analysis. Smokers with multiple risks for poor cessation outcomes exposed to a guideline-based program of health education during routine healthcare encounters had sustained smoking cessation rates that compare favorably with published National Health Interview Study population cessation rates. An additional educator contact after the baseline was a predictor of cessation. The findings support development of cessation programs in which health educators are integrated into clinical care settings.     

Predicting mortality and healthcare utilization with a single question

Objective. We compared single‐ and multi‐item measures of general self‐rated health (GSRH) to predict mortality and clinical events a large population of veteran patients. Data Source/Study Setting. We analyzed prospective cohort data collected from 21,732 patients as part of the Veterans Affairs Ambulatory Care Quality Improvement Project (ACQUIP), a randomized controlled trial investigating quality‐of‐care interventions. Study Design. We created an age‐adjusted, logistic regression model for each predictor and outcome combination, and estimated the odds of events by response category of the GSRH question and compared the discriminative ability of the predictors by developing receiver operator characteristic curves and comparing the associated area under the curve (AUC)/c‐statistic for the single‐ and multi‐item measures. Data Collection/Extraction Methods. All patients were sent a baseline assessment that included a multi‐item measure of general health, the 36‐item Medical Outcomes Study Short Form (SF‐36), and an inventory of comorbid conditions. We compared the predictive and discriminative ability of the GSRH to the SF‐36 physical component score (PCS), the mental component score (MCS), and the Seattle index of comorbidity (SIC). The GSRH is an item included in the SF‐36, with the wording: “In general, would you say your health is: Excellent, Very Good, Good, Fair, Poor?” Principal Findings. The GSRH, PCS, and SIC had comparable AUC for predicting mortality (AUC 0.74, 0.73, and 0.73, respectively); hospitalization (AUC 0.63, 0.64, and 0.60, respectively); and high outpatient use (AUC 0.61, 0.61, and 0.60, respectively). The MCS had statistically poorer discriminatory performance for mortality and hospitalization than any other other predictors (p<.001). Conclusions. The GSRH response categories can be used to stratify patients with varying risks for adverse outcomes. Patients reporting “poor” health are at significantly greater odds of dying or requiring health care resources compared with their peers. The GSRH, collectable at the point of care, is comparable with longer instruments.     

Factors associated with health service utilization patterns in low-income women

Little is known about the relationship of demographic, health, and psychosocial factors with health services utilization over time among low-income female heads of household. In a case-control study conducted between 1991 and 1997, 273 homeless and low-income housed mothers living in Worcester, Massachusetts were interviewed at baseline and at a two-year follow-up. The use of outpatient and emergency department care in this study sample was examined. High usage patterns were found at baseline. At the two-year follow-up, poor health status, non-White race, and fewer supportive relationships were significantly associated with frequent emergency department visits. Women with higher rates of ongoing outpatient medical care visits were more likely to have fewer social supports and more bodily pain than women with lower rates of ambulatory care usage. Mental health and victimization were not associated with service use patterns. In order to address poor women's needs in a more effective and potentially less costly way, health programs must understand their need for social support and culturally responsive services.     

Monitoring Outcomes of Care in Older People in a UK Community Setting

Although process measures of care have traditionally been used to assess the quality of healthcare, there is little evidence, for the majority of healthcare activities, to support a clear relationship between processes of care and resulting health gains. Outcomes monitoring is increasingly being advocated as a vital component of healthcare, particularly with the increasingly aging population. A consensus is emerging that routine systems of outcome monitoring are fundamental to rational clinical decision-making and public policy.There are several issues that need to be considered when implementing a routine system of outcome monitoring; this article addresses these issues in older people within a UK community setting in the context of an innovative observational feasibility study (The North East Fife Outcomes Project). This project (i) determined which outcomes of health and social care are the most important to this patient group; and (ii) identified appropriate measures for relevant outcomes suitable for use in a community setting. Key patient characteristics and relevant clinical and social care process variables were then recorded, concomitant variables such as disease severity and comorbidities were taken into account and quality-of-life assessment measures recorded. For the success of any outcomes monitoring system, feedback to end-users is important. The North East Fife Project will assess the feasibility and value of feedback at the individual patient level and at the aggregate level.More research, particularly from large observational studies, is needed to address reliability and validity issues, biases and inaccuracies with routinely collected data and to further determine the value of routine outcomes monitoring.     

内关穴位注射维生素B1治疗妊娠剧吐的人文关怀护理观察

目的探究妊娠剧吐患者在内关穴位注射维生素B1治疗的基础上采用人文关怀护理对患者生活质量和心理影响的临床效果观察。方法现选取2018年1月—2019年1月来我院就诊的128例妊娠剧吐患者为研究对象,按照随机数字表法将其分为使用常规护理的对照组和使用人文关怀护理的试验组,每组各64例,两组患者均接受双侧内关穴位注射维生素B1治疗,在门诊治疗3 d后填写健康状况调查表、症状自评量表、满意度调查表,判断不同护理方式对两组患者的影响。结果试验组患者临床症状评分和健康症状评分均优于对照组,且试验组对护理的满意度更高,所有数据组间差异具有统计学意义(P<0.05)。结论采用人文关怀护理可以使内关穴位注射维生素B1治疗妊娠剧吐患者的临床症状和生活质量明显改善,对护理的满意度显著提升,有助于患者恢复。     

Patients’ and Healthcare Professionals’ Perspectives on Better Use of Patient-Reported Outcome Measures in Head and Neck Cancer

ObjectivesPatients with head and neck cancer (HNC) are often highly affected by disease and treatment, resulting in impaired physical functioning and quality of life. Therefore, evaluation of patients’ psychosocial and functional outcomes can be facilitated by patient-reported outcome measures (PROMs). By providing the patients’ own perspectives, PROMs are crucial to improving patient-centered care. This study aimed to improve understanding of the perceived value of PROMs in HNC care and how to optimize their clinical value based on patients’ and multidisciplinary healthcare professionals’ (HCPs) perspectives.MethodsPopulation-based surveys among patients with HNC through their patient association and among HCPs nationwide through the Dutch Head and Neck Audit.ResultsA total of 54 patients and 40 multidisciplinary HCPs from all 14 nationwide HNC centers (100%) responded. For patients, the most important element of patient-reported outcome collection systems was including a call to action for those with worse-than-average scores (28%), whereas clinicians found discussing scores during clinical visits the most important (39%). Although 16% of clinicians found short completion time the most important element, none of the patients selected completion time as most important. Additionally, 17% of patients stated completion time was not an issue, provided clinicians would use the outcomes for clinical purposes.ConclusionsAlthough patients and clinicians acknowledged the value of patient-reported outcomes, patients would like to be more involved in the clinical implications of their outcomes. Enhancing patients’ involvement by a call to action and providing feedback on their scores during outpatient clinic visits may improve the clinical value of PROMs.