Triangulating patient and clinician perspectives on clinically important differences in health-related quality of life among patients with heart disease.

Objective: To use triangulation methodology to better understand clinically important differences (CIDs) in the health-related quality of life (HRQoL) of patients with heart disease.

Data Sources/study Setting: We used three information sources: a nine-member expert panel, 656 primary care outpatients with coronary artery disease (CAD) and/or congestive heart failure (CHF), and the 46 primary care physicians (PCPs) treating these outpatients. From them, we derived CIDs for the Modified Chronic Heart Failure Questionnaire (CHQ) and the Medical Outcomes Study Short Form 36-Item Health Status Survey, Version 2 (SF-36).

Validity of patient-reported health-related quality of life global ratings of change using structural equation modeling.

Background: Patient-perceived global ratings of change are often used as anchors of health-related quality of life (HRQoL) since they are easy for clinicians to interpret and incorporate the patient's perception of change as a means to capture clinical significance. Although this approach may be preferred, the validity of the anchor-based approach is currently under scrutiny.

Objective: To estimate the explained variation in single-item domain-specific global ratings of change (GRCs) that is accounted for by time 1 (T1) and time 2 (T2) domain-specific summary change scores from the Short-Form 36, V2 (SF-36) Health Survey in asthma primary care patients.

Measuring patient and clinician perspectives to evaluate change in health-related quality of life among patients with chronic obstructive pulmonary disease.

Context: Many treatments aim to improve patients' health-related quality of life (HRQoL), and many care guidelines suggest assessing symptoms and their impact on HRQoL. However, there is a lack of consensus regarding which HRQoL outcome measures are appropriate to assess, and how much change on those measures depict significant HRQoL improvement.

Objective: We used triangulation methods to identify and understand clinically important differences (CIDs) for the amount of change in HRQoL that reflects both health professionals and patients' values, among patients with chronic obstructive pulmonary disease (COPD).

A comparison of traditional and Rasch cut points for assessing clinically important change in health-related quality of life among patients with asthma.

Background: Patient-perceived change in health-related quality of life (HRQoL) domains has often been classified using a 15-point patient transition rating scale. However, traditional change levels of trivial ( - 1, 0, or 1), minimal (2, 3 or - 2, - 3), moderate (4, 5 or - 4, - 5) and large (6, 7 or - 6, - 7) on this scale have been arbitrarily defined and originally assumed that change related to an improvement was the same as that for a decline.

Objective: To compare traditional and Rasch partial credit model-derived cut points and the mean changes for each change categorization when assessing clinically important change in asthma-specific HRQoL.

Physician-estimated disease severity in patients with chronic heart or lung disease: a cross-sectional analysis.

Background: We evaluated how well physicians' global estimates of disease severity correspond to more specific physician-rated disease variables as well as patients' self-rated health and other patient variables.

Methods: We analyzed baseline data from 1662 primary care patients with chronic cardiac or pulmonary disease who were enrolled in a longitudinal study of health-related quality of life (HRQoL). Each patient's primary physician rated overall disease severity, estimated the two-year risk of hospitalization and mortality, and reported the use of disease-specific medications, tests, and subspecialty referrals.

Interpreting quality-of-life data: methods for community consensus in asthma.

Background: Change in health-related quality of life (HRQoL) is an important outcome in asthma treatment. Patient and provider consensus on how to determine thresholds for identifying important improvements and declines, however, has not been achieved.

Objective: To search for consensus in clinically important difference (CID) thresholds for HRQoL change from 3 points of view: (1) an expert panel of physicians who treat patients with asthma and measure the HRQoL of their patients, (2) asthmatic patients, and (3) the primary care physicians (PCPs) of these asthmatic patients.

A comparison of clinically important differences in health-related quality of life for patients with chronic lung disease, asthma, or heart disease.

Objective: On the eight scales of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), Version 2, we compared the clinically important difference (CID) thresholds for change over time developed by three separate expert panels of physicians with experience in quality of life assessment among patients with chronic obstructive pulmonary disease (COPD), asthma, and heart disease.

Study Design: We used a modified Delphi technique combined with a face-to-face panel meeting within each disease to organize and conduct the consensus process among the expert panelists, who were familiar with the assessment and evaluations of health-related quality of life (HRQL) measures among patients with the panel-specific disease.

Principal Findings: Each of the expert panels first determined the magnitude of the smallest numerically possible change on each SF-36 scale, referred to as a state change, and then built their CIDs from this metric.

Test-retest reliability of the Mirowsky-Ross 2 x 2 Index of the Sense of Control.

This study investigated the short-term stability of the 1991 Mirowsky-Ross 2 x 2 Index of the Sense of Control. From an ongoing longitudinal study, 304 subjects were randomly selected for test-retest interviews occurring 1 to 4 days after their regularly scheduled first follow-up interview. Test-retest reliability was assessed at the item level using percent agreement and weighted kappa.

Clinically important differences in health status for patients with heart disease: an expert consensus panel report.

Background: The purpose of the study was to develop clinically important difference (CID) standards for patients with coronary artery disease and congestive heart failure that identify small, moderate, and large intraindividual changes with time in a modified version of the Chronic Heart Failure Questionnaire (CHQ) and the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36, version 2). Prior work in ascertaining important difference standards for the CHQ have centered on patient-perceived changes. No important difference standards for the SF-36 have been published for patients with heart disease.

Clinically important differences in health-related quality of life for patients with asthma: an expert consensus panel report.

Background: Standards for change in health-related quality of life (HRQoL) measures used among asthmatic patients have been established by considering only patient preferences to determine important differences and may not reflect an informed clinical evaluation of change.

Objective: To establish clinically important difference (CID) standards through the consensus of an expert physician panel for the Juniper Asthma Quality of Life Questionnaire (AQLQ) and Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36, version 2) when used to measure HRQoL among asthmatic patients.

Methods: We organized an 8-person panel of physicians familiar with measuring HRQoL among asthmatic patients with the AQLQ and the SF-36.

Age, aging, and the sense of control among older adults: a longitudinal reconsideration.

Objectives: The purpose of this study was to first estimate the crude cross-sectional and longitudinal associations between age and the sense of control, and then to partition any joint variance attributable to a theoretically specified set of potential confounders.

Methods: Sense of control was measured at baseline and at each of six bimonthly follow-up interviews among 1,662 patients at two medical centers. Potential confounders were measured at baseline.

9-11, personal stress, mental health, and sense of control among older adults.

Objectives: We assessed whether the events of 9-11 affected the personal stress, mental health, or sense of control of older adults participating in an ongoing longitudinal study, and whether baseline characteristics were associated with the magnitude of any such changes.

Methods: Personal stress, mental health, and sense of control were measured at baseline and at six bimonthly follow-up interviews among 1662 patients. Of these, 437 had the opportunity to complete three interviews before and after 9-11, with 291 (67%) completing all six.

Eponyms and the diagnosis of aortic regurgitation: what says the evidence?

Background: Chronic aortic regurgitation can lead to significant morbidity and mortality. For more than a century, numerous eponymous signs of aortic regurgitation have been described in textbooks and the literature.

Purpose: To compare current textbook content with the peer-reviewed literature on the eponymous signs of aortic regurgitation and to assess the role of these signs in clinical practice.

Clinically important changes in health-related quality of life for patients with chronic obstructive pulmonary disease: an expert consensus panel report.

Objective: Without clinical input on what constitutes a significant change, health-related quality of life (HRQoL) measures are less likely to be adopted by clinicians for use in daily practice. Although standards can be determined empirically by within-person change studies based on patient self-reports, these anchor-based methods incorporate only the patients' perspectives of important HRQoL change, and do not reflect an informed clinical evaluation. The objective of this study was to establish clinically important difference standards from the physician's perspective for use of 2 HRQoL measures among patients with chronic obstructive pulmonary disease (COPD).