title: Using the Physician Global Assessment in a clinical setting to measure and track patient outcomes.
abstract: OBJECTIVE
  In dermatology, the development of objective, standardized quality measures that can be used in a clinical setting is important to be able to respond to the needs of payers and credentialing and licensure bodies and to demonstrate dermatologic value.
  
  
  OBJECTIVE
  To examine the feasibility of using Physician Global Assessment (PGA) scores to collect and track patient acne and psoriasis outcomes over time.
  
  
  METHODS
  The PGA severity scores were included on physicians' billing sheets for patients with acne and psoriasis seen at a tertiary care center outpatient dermatology clinic from June 2011 through October 2012. A subset of patients from 5 clinics completed Patient Global Assessments (PtGAs) between November 2011 and May 2012. Thirty dermatology clinicians saw a total of 2770 patients with acne and 1516 patients with psoriasis in clinic, recording PGA scores for each patient. The PtGA scores were collected from 52 and 103 patients with acne and psoriasis, respectively, within the larger sample.
  
  
  METHODS
  Longitudinal PGA severity scores were collected for acne and psoriasis. The PGA severity scores were analyzed over time, with the hypothesis that patient scores for both acne and psoriasis would improve between the initial and follow-up visits. The PtGA scores from a subset of clinics and dates were compared with PGA scores to assess within-clinic reliability, with the hypothesis that there would be good agreement between clinician and patient assessments.
  
  
  RESULTS
  New patient PGA outcomes showed considerable improvement over time. At 3-month follow-up, 14.6% of the acne cohort was graded as effectively clear, compared with 2.1% at baseline (P < .001). Similarly, at 3-month follow-up, 22.3% of the psoriasis cohort was graded as effectively clear, compared with 3.1% at baseline (P < .001). Additionally, interobserver agreement between PGA and PtGA scores was good (acne, κ = 0.68; psoriasis, κ = 0.70).
  
  
  CONCLUSIONS
  The PGA can be readily incorporated into practice to track patient acne and psoriasis outcomes over time, representing an opportunity for dermatologists to evaluate performance and validate practice guidelines.
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston2Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Pascoe
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Monica
authors.initials: M
authors.lastname: Enamandram
authors.affiliation: Department of Dermatology, University of Massachusetts Medical School, Worcester.
authors.forename: Kristen C
authors.initials: KC
authors.lastname: Corey
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston5Harvard Medical School, Boston, Massachusetts.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Cheng
authors.affiliation: University of Massachusetts Medical School, Worcester.
authors.forename: Emilia J
authors.initials: EJ
authors.lastname: Javorsky
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Sung
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Donahue
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston5Harvard Medical School, Boston, Massachusetts.
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Kimball
mesh_terms: D000152:Acne Vulgaris / Q000473:pathology / Q000628:therapy*; D000328:Adult; D003880:Dermatology / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011565:Psoriasis / Q000473:pathology / Q000628:therapy*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult