The use of structured questionnaires to assess symptoms, disease activity, and quality of life (QOL) and to guide treatment of dermatologic disease (DD) and rheumatologic disease (RD) improves outcomes. Further, psychosocial and behavioral issues (e.g., anxiety, depression, and maladaptive illness beliefs and coping) often have greater impact on QOL and disability than disease activity per se. However, there are no practical, integrated systems for assessing biomedical, psychosocial, and behavioral (BPSB) issues--and physicians often lack the time and resources for such total care. SOLUTION: Our goal is to extend an existing online patient (pt) self-assessment system, called CarePrep, to support integrated BPSB care for RD and DD. For Phase 1 we focus on psoriasis (Ps) and psoriatic arthritis (PsA), which present challenging BPSB issues. A basic version of CarePrep is now operational in clinic, allowing pts to easily enter BPSB data over the Internet from any site. We will expand content to assess the full spectrum of BPSB, QOL, and disability issues relevant to DD and RD. The CarePrep software is maintainable, scalable, and ready to support this work. Moreover, our imperative is to enhance dermatologist-rheumatologist collaboration, physician-pt communication, and pt-centered care, and to generate sufficient value to pts and clinicians to warrant use in routine care, where CarePrep will track the presentation, natural history, and treatment responsiveness and transparently support research. Thus CarePrep is much more than an automated system for administering questionnaires. APPROACH: Methods are straightforward: item development, content validation, and then preliminarily testing reliability, validity, and feasibility in clinic.
Aim 1) Adapt and Extend CarePrep for Ps/PsA: Working with experts, we will review established instruments and existing CarePrep content;develop a plan for the RD/DD assessment;and then prioritize elements of a core Ps/PsA assessment of appropriate scope for Phase 1. We will revise or install content, deploy the system, and start pt testing, gathering feedback to guide refinement.
Aim 2) Validate CarePrep for Ps/PsA: We will interview pts to assess their understanding and thought process in responding;assess validity using pt and expert ratings of CarePrep report accuracy;and do structured interviews to compare with CarePrep data.
Aim 3) Assess feasibility using MD and pt self-reports. IMPACT rests upon delivering a BPSB care management system for DD and RD that: 1) tracks disease status, QOL, and disability--identifying pts in need of early intervention or treatment modifications;2) uncovers and assesses BPSB issues that warrant treatment;3) helps individualize timely medical and psychosocial interventions, reducing costly, inappropriate care;4) supports physicians delivering integrated care by facilitating efficient BPSB care in medical settings and 5) transparently supports research in practice settings, such as examining the impact of integrated BPSB care on outcomes and costs. Improving cost-effectiveness;benefiting all stakeholders;and facilitating research will justify routine use and sustain impact.
Psychosocial and behavioral issues (e.g., anxiety, depression, or feeling helpless) amplify the impact of dermatologic and rheumatologic disease on patients'quality of life and disability. Our long-term goal is to integrate psychosocial and behavioral care with biomedical treatment from the outset to improve the targeting of care to a patient's individual needs. The societal value of the work is therefore to improve outcomes for patients while reducing unnecessary care and costs. We will accomplish this by adapting an existing online self-assessment system to gather directly from patients the full spectrum of data relevant to the care and investigation of dermatologic and rheumatologic disorders. Focusing initially on psoriasis and psoriatic arthritis, we will first develop disease-relevant components covering skin, joint, and other physical symptoms and psychological, social, behavioral, and quality of life issues. Then, we will test accuracy, feasibility, and ease of use of the assessment tool. Unfortunately, most physicians are unable to effectively deal with their patients'psychosocial and behavioral issues. Therefore, in Phase 2 of the proposed work we will develop our assessment tool to provide systems support for flexible, integrated interventions that efficiently deliver biopsychosocial and behavioral care, and then conduct a study to examine the impact on outcomes and costs.
