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Explore This IssueOctober 2007
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What Data to Gather?
What measures should be used in practice is “still an unsettled question,” says Timothy Harrington, MD, a rheumatologist at UW Health, the academic health system for the University of Wisconsin in Madison.
The Health Assessment Questionnaire (HAQ) is one candidate for evaluating RA in the clinic, says Dr. Harrington, who is also a professor of medicine at the University of Wisconsin School of Medicine and Public Health. This measure is simple and durable and can separate the physician’s assessment from the patient’s.
Other examples of outcomes measures that clinicians use include joint scores, X-rays, laboratory tests, and physician and patient global assessment status, says Eric Schned, MD, a rheumatologist at Park Nicollet Clinic in Minneapolis and a TR editorial board member. The Disease Activity Score (DAS), and its variants, are other measures that are increasingly used in addition to other activity scores, he adds.
Many comprehensive outcomes measures, such as DAS-28, were developed for clinical trials, says Dr. Harrington, and he notes that collecting the necessary data and calculating results of such measures in real time and then applying them to clinical decision making is complicated for physicians in an office setting.
When deciding which outcomes measures to employ in their practice, rheumatologists need to remember that more than one assessment is advisable, says Frederick Wolfe, MD, director of the National Data Bank for Rheumatic Diseases and clinical professor of medicine at the University of Kansas School of Medicine. Rheumatologists should also know the magnitude of change that is considered to be significant for each measure.
For example, an increase of 0.25 units in the HAQ Disability Index could be due to random variation or error, says Dr. Wolfe, who used outcomes measures in private practice for more than 25 years. If tools like the HAQ are used with other patient assessments, it is easier to interpret smaller changes.
Dr. Wolfe also advises using these outcomes measures over time because they can vary widely in an individual patient. They may also be influenced by various factors, such as other illnesses or pain not related to RA, he explains.
Collection and Analysis
No matter which outcomes measures are used, each practice must determine the best way to collect and analyze their data. Managing these logistics may be difficult. “Someone has to hand out forms to patients, collect them at the office visit, and enter data into the electronic or written record,” says Dr. Schned.