Improving patient function: a randomized trial of functional disability screening.
OBJECTIVE
To test whether a 34-item functional status questionnaire measuring physical, psychological, and social function can be used by physicians in practice to help improve their patients' outcomes.


METHODS
Prospective randomized trial.


METHODS
Community internal medicine practices.


METHODS
Five hundred and ten continuing patients with functional disabilities who saw their physicians at least four times a year. PHYSICIANS: Seventy-six UCLA clinical volunteer faculty who are internists in community office practices.


METHODS
Physicians and their patients were randomly assigned to the experimental or the control group. Experimental group physicians attended a 2-hour multimedia educational session and received four functional status reports on each of their study patients over a 1-year period. Control group physicians received no education and no functional status feedback. Control group and experimental group patients were tested for functional status with the functional status questionnaire every 4 months for 1 year. Both groups also completed monthly diaries that measured use of health services. Experimental group physicians answered an anonymous evaluation questionnaire at 6 months after study entry.


RESULTS
Forty-three percent of experimental group physicians reported that they had used the functional status questionnaire to change therapy. Ninety-five percent reported that it was useful and accurate. Patient diaries did not show any difference between experimental group patients and control group patients in number of medications used, visits to physicians or other health professionals, equipment purchased, diet, or exercise programs. There were no significant differences between experimental and control group patients at exit from the study on any functional status or health outcome measure.


CONCLUSIONS
A more powerful intervention than a 2-hour educational session and the regular provision of functional status information is needed to help office-based internists improve patient outcomes.
Rubenstein
L V
LV
University of California, Los Angeles.
Calkins
D R
DR
Young
R T
RT
Cleary
P D
PD
Fink
A
A
Kosecoff
J
J
Jette
A M
AM
Davies
A R
AR
Delbanco
T L
TL
Brook
R H
RH
D000203:Activities of Daily Living; D001741:Black or African American; D000368:Aged; D003627:Data Interpretation, Statistical; D004185:Disability Evaluation; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010358:Patient Participation; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires