Objective. The goal of this project was to develop a more comprehensive and sensitive version of the Arthritis Impact Measurement Scales (AIMS).Methods. AIMS scale items were revised, and 3 new scales were added to evaluate arm function, work, and social support. Sections were also added to assess satisfaction with function, attribution of problems to arthritis, and self-designation of priority areas for improvement. The new instrument was designated the -2.A pilot test of format and content and a performance test of reliability and validity were carried out.Results. Questionnaire completion times in a pilot study of 24 subjects averaged 23 minutes, and evaluations were positive regarding the instrument's length and ease of completion, and the subjects' willingness to complete serial forms and return them by mail. Mea- Submitted for publication February 20, 1991; accepted in revised form August 19, 1991. surement performance was tested in 408 subjects: 299 with rheumatoid arthritis (RA) and 109 with osteoarthritis (OA); 45 of these subjects completed a second AIMS2 within 3 weeks. Internal consistency coefficients for the 12 scales were 0.72-0.91 in the RA group and 0.74-0.96 in the OA group. Test-retest reliability was 0.78-0.94. All withm-scale factor analyses produced single factors, except for mobility level in OA. Validity analyses in both the RA and the OA groups showed that patient designation of an area as a problem or as a priority for improvement was significantly associated with a poorer AIMS2 scale score in that area. Reliability, factor analysis, and validity results were consistent in age, sex, and education subgroups. Satisfaction was moderately correlated with level of function in the same health status area, and the satisfaction items formed a reliable scale. Responses to the arthritis attribution items showed that most dysfunction in this sample was due to arthritis. Conclusion.The AIMS2 is a revised and expanded health status questionnaire with excellent measurement properties that should be useful in arthritis clinical trials and in outcomes research.
The Arthritis Impact Measurement Scales (AIMS) have been developed to assess the health status of arthritis patients. In this study, the self-administered AIMS questionnaire, which includes scales designed to measure the physical, psychologic, and social aspects of health status, was completed by 625 patients with various forms of arthritis. A comprehensive battery of analytic techniques was used to investigate the performance of these scales in this large sample. The results confirmed the reliability and validity of the AIMS instrument. They also showed that AIMS performs well ia at least 4 major types of arthritis, in a range of sociodemographic groups, and across time. These findings emphasize the strengths of the AIMS approach and suggest that the instrument will prove useful as a tool to assess arthritis outcome in a wide variety of clinical settings.The Arthritis Impact Measurement Scales (AIMS) are batteries of health status questions that are designed to assess the physical, emotional, and social well-being of individuals with rheumatic diseases. The self-administered AIMS instrument has been developed to improve the measurement of patient outcome in arthritis (1). Although the AIMS approach is based on previous work in health status measurement (2-6), the measurement properties of any new instrument must be documented before it is widely accepted and applied. Our preliminary findings on the AIMS instrument indicated acceptable levels of reliability and validity (7), but they were based on a relatively small sample size and were limited in analytic and clinical scope. This report reexamines the reliability and validity of the AIMS instrument through the use of a larger sample and a variety of additional analytic approaches. It presents new measures of test-retest reliability and estimates of construct validity, based on clinical data. This report also attempts to estimate the clinical applicability of the AIMS approach by providing the first descriptions of AIMS performance in the major rheumatic diseases, in various sociodemographic groups, and across time. MATERIALS AND METHODSInstrument description. The current AIMS instrument contains 45 health status questions, grouped into 9 component scales: Mobility, Physical Activity, Dexterity, Household Activities, Activities of Daily Living, Anxiety, Depression, Social Activity, and Pain. The scales contain 4-7 items, and each item, depending on the phrasing of the question, contains 2-6 possible responses. Item responses are summed by group to produce scale scores and then brought to a normal standard of 0-10 for further analysis. The instrument used was identical to that described in our original report, with 2 exceptions. First, the original Social Role scale has been renamed Household Activities to better reflect the contents of the scale. The items it contains are
A multidimensional index that measures the health status of individuals with arthritis has been developed. The Arthritis Impact Measurement Scales (AIMS) are a combination of previously studied and newly created health status scales which assess physical, emotional, and social well-being. The self-administered AIMS questionnaire has been pilot tested in a mixed arthritis population. Results indicate that the instrument is practical and that it generates scalable, reliable, and valid measures of both aggregated and disaggregated health status. The AIMS approach to health status measurement should prove useful for evaluating the outcomes of arthritis treatments and programs.The worth of a new medical practice or policy ultimately depends upon the effect it produces on health (1,2). Thus, the development of reliable, valid, and practical outcome measures is a priority area for health services research. Although the end results of health care can be assessed by measuring a variety of parameters such as satisfaction and cost, health status is the most important component of outcome (3,4).
We determined if infection indicators were sufficiently consistent across health plans to allow comparison of hospitals’ risks of infection after coronary artery bypass surgery. Three managed care organizations accounted for 90% of managed care in eastern Massachusetts, from October 1996 through March 1999. We searched automated inpatient and outpatient claims and outpatient pharmacy dispensing files for indicator codes suggestive of postoperative surgical site infection. We reviewed full text medical records of patients with indicator codes to confirm infection status. We compared the hospital-specific proportions of cases with an indicator code, adjusting for health plan, age, sex, and chronic disease score. A total of 536 (27%) of 1,953 patients had infection indicators. Infection was confirmed in 79 (53%) of 149 reviewed records with adequate documentation. The proportion of patients with an indicator of infection varied significantly (p<0.001) between hospitals (19% to 36%) and health plans (22% to 33%). The difference between hospitals persisted after adjustment for health plan and patients’ age and sex. Similar relationships were observed when postoperative antibiotic information was ignored. Automated claims and pharmacy data from different health plans can be used together to allow inexpensive, routine monitoring of indicators of postoperative infection, with the goal of identifying institutions that can be further evaluated to determine if risks for infection can be reduced.
Information technologies (ITs) have now entered the everyday workflow in a variety of healthcare providers with a certain degree of independence. This independence may be the cause of difficulty in interoperability between information systems and it can be overcome through the implementation and adoption of standards. Here we present the case of the Lombardy Region, in Italy, that has been able, in the last 10 years, to set up the Regional Social and Healthcare Information System, connecting all the healthcare providers within the region, and providing full access to clinical and health-related documents independently from the healthcare organization that generated the document itself. This goal, in a region with almost 10 millions citizens, was achieved through a twofold approach: first, the political and operative push towards the adoption of the Health Level 7 (HL7) standard within single hospitals and, second, providing a technological infrastructure for data sharing based on interoperability specifications recognized at the regional level for messages transmitted from healthcare providers to the central domain. The adoption of such regional interoperability specifications enabled the communication among heterogeneous systems placed in different hospitals in Lombardy. Integrating the Healthcare Enterprise (IHE) integration profiles which refer to HL7 standards are adopted within hospitals for message exchange and for the definition of integration scenarios. The IHE patient administration management (PAM) profile with its different workflows is adopted for patient management, whereas the Scheduled Workflow (SWF), the Laboratory Testing Workflow (LTW), and the Ambulatory Testing Workflow (ATW) are adopted for order management. At present, the system manages 4,700,000 pharmacological e-prescriptions, and 1,700,000 e-prescriptions for laboratory exams per month. It produces, monthly, 490,000 laboratory medical reports, 180,000 radiology medical reports, 180,000 first aid medical reports, and 58,000 discharge summaries. Hence, despite there being still work in progress, the Lombardy Region healthcare system is a fully interoperable social healthcare system connecting patients, healthcare providers, healthcare organizations, and healthcare professionals in a large and heterogeneous territory through the implementation of international health standards.
Objective. This study documents the measurement properties of a brief, self-administered questionnaire of disease signs and symptoms in patients with rheumatoid arthritis. Measurement of disease signs and symptoms is a key aspect of outcome evaluation in rheumatology-
Health status is a key aspect of quality of life that may be addressed and affected by health care. The measurement of this construct requires the identification of unique and relevant components of health status that can be operationally defined by specific scales or scale groupings. We explored the components of health status that are operationalized by the Arthritis Impact Measurement Scales (AIMS). Prior testing has shown that the AIMS measures delineate at least 3 components of health status: Physical Function, Psychological Status, and Pain. This 3‐component model, however, can be theoretically and empirically restrictive. Using AIMS responses from a rheumatoid arthritis (RA) patient population, our investigation, through factor analyses, identifies 5 components of health status in this chronic disease: Lower Extremity Function, Upper Extremity Function, Affect, Symptom, and Social Interaction. It is proposed that these intuitively reasonable and measurable components constitute the core of the health status construct for individuals with RA. These 5 components could also prove central to the assessment of health status in other rheumatic diseases. Future studies of health status in RA should include tested measures to assess these 5 components.
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