Achieving Consensus on Patient-Reported Outcome Measures in Clinical Practice for Inflammatory Skin Disorders

On Behalf of International Dermatology Outcome Measures and the American Academy of Dermatology
Published:September 13, 2019DOI:https://doi.org/10.1016/j.jaad.2019.09.008
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      Abstract

      Background

      The 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 (PROMs) are also important, we aimed to achieve consensus on a PROM for clinical practice.

      Methods

      Patients and providers participated in a consensus-building study using a modified-Delphi technique. Voting focused on identifying: (i)minimal set of assessments for clinical practice; (ii)patient-global assessments (PtGAs); (iii)Skindex instruments; and (iv)final instrument selection for quality improvement.

      Results

      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 for clinical practice. The most preferred PtGA was a 5-point PtGA (0=clear to 4=severe) with an optional check-box: “worst ever”. A new metric assessing change since treatment initiation called “trajectory measure” was proposed. Stakeholders preferred Skindex instruments over PtGAs and a trajectory measure for clinical practice.

      Conclusions

      PtGAs as standalone measures do not adequately capture the patient’s assessment of disease severity or impact of care. The combination of PtGAs with Skindex or other measure of health-related quality of life may provide a more comprehensive evaluation of patients in clinical practice.

      Key words

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