An evidence-based medical visit for patients with rheumatoid arthritis based on standard, quantitative scientific data from a patient MDHAQ and physician report.
An evidence-based visit is described based on quantitative, standard scientific data on two simple forms for a patient and a physician. The focus is rheumatoid arthritis (RA), but the principles may be applied to most rheumatic and chronic diseases. A quantitative patient history is recorded on a selfreport multidimensional health assessment questionnaire (MDHAQ), which includes scales for physical function, pain, patient global estimate, psychological distress, change in status, exercise status, morning stiffness, fatigue, and a template to score RAPID3 (routine assessment of patient index data 3). RAPID3, an index of only patient self-report measures, distinguishes active from control treatments in clinical trials at similar levels to a disease activity score (DAS28) and clinical disease activity index (CDAI) but is calculated in 5 seconds, compared to almost 2 minutes for DAS28 or CDAI. The MDHAQ also includes traditional "medical" matters-a self-report joint count, review of systems, recent medical history, medications, demographic data, and consents for future monitoring by mail and sharing data with research colleagues; these queries enhance acceptance by patients and save time for doctors. Patient questionnaire physical function scores-not radiographs or laboratory tests-are the most significant prognostic markers for long-term work disability and premature death in RA. The physician completes a "doctor evaluation" (DOCEVAL) form, which includes four visual analog scales for overall status, inflammation, damage, and "neither" (usually fibromyalgia), reflecting quantitatively the expertise of a rheumatologist to classify the etiology of pain and distress into one of these three broad categories in formulating a treatment plan. Quantitative data from patients and doctors on an evidence-based visit can advance rheumatology clinical care and clinical science.
Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, New York 100003, USA. tedpincus@gmail.com
Theodore
T
Pincus
Isabel
I
Castrejón
D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D057189:Checklist; D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D006801:Humans; D008487:Medical History Taking; D009819:Office Visits; D010808:Physical Examination; D010820:Physicians; D011237:Predictive Value of Tests; D011379:Prognosis; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires