Efforts to improve the quality of dermatological care have been impaired by the lack of a quantitative measure of the impact of skin disease on patients' health, to assess outcomes of the disease as well as therapeutic interventions. The long-term objective of this application is improvement in the quality of care for skin diseases, and the specific goal of the project is to develop a scientifically valid measure of disability due to the skin in patients with chronic dermatological disease. The project has three specific aims: (1) to identify factors contributing to the impact of skin disease in patients with chronic dermatological illness, (2) to design a practical questionnaire of patients and their physicians which will determine these factors for a given patients and will generate numerical indices to reflect their answers (the Skin Disease Impact Profile, the SDIP), and, (3) using standard clinimetric criteria, to test the scientific validity of the SDIP as a measure of the impact on patients of skin disease. Fifteen faculty dermatologist at University Hospitals of Cleveland will identify objectives aspects of skin eruption--called severity aspects-- which contribute to their severity. Thirty patients with chronic skin disease of all types will be selected from the department practices, and will identify aspects of their skin diseases--called disability aspects-- which cause them disability, dysfunction, or suffering. The ten most frequently identified severity aspects and disability aspects will be empirically categorized into logical subscales based on their description of related aspects of the skin disease. Using these disease aspects, a 20-item survey instrument will be developed for patients and their physicians; each question will have possible answers varying form 0% to 100% depending on the perceived contribution of the aspect to the severity or disability caused by the disease. The SDIP comprises to indices derived from this instrument, one consisting of 20 discreet answers about the disease aspects, and one consisting of the mean subscale scores. To test the rigor of the SDIP, standard clinimetric criteria of scientific validity will be employed. Using Spearman correlation coefficient, test-retest reliability and inter-rater reliability will be calculated for instruments administered to selected patients 48 hours apart and, for selected patients, two physicians who have examined them. Clinical sensibility will be judged by independent physician consultants using a empirical rating scale, and statistical correlation among items in each subscales will be calculated using Cronbach's coefficient a. Criterion validity will be estimated as the correlation between the SDIP and a global assessment of severity and disability related to the disease. Finally, sensitivity to change will be calculated after a month of continued therapy.
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