THE DUKE SEVERITY OF ILLNESS CHECKLIST (DUSOI) FOR MEASUREMENT OF SEVERITY AND COMORBIDITY

The Duke Severity of Illness Checklist (DUSOI) was evaluated on 414 pr imary care adult patients using data collected both by medical provide rs at the time of the patient visit and later by a chart auditor. Seve rity scores for individual diagnoses were determined by summing the ra tings for four non-disease-specific parameters: symptom level, complic ations, prognosis without treatment, and expected response to treatmen t. Mean diagnosis severity scores (scale 0-100) among the 21 most prev alent diagnoses varied from a low of 13.9 for menopausal syndrome to a high of 43.0 for sprains and strains. An overall severity score was c alculated by combining diagnosis severity scores and giving highest we ights to the most severe diagnoses. Provider-generated overall severit y scores (mean = 43.3) and auditor-generated overall severity scores ( mean = 38.9) were significantly correlated (coefficient of agreement = 0.59, p < 0.0001). Diagnoses varied in their individual contribution to the overall severity score, from 8.9% for lipid disorder to 90.0% f or sprains and strains. Separate comorbidity severity scores were calc ulated to measure the severity of all of each patient's health problem s except the diagnosis under study. For example, patients with menopau sal syndrome had co-existing health problems which generated a high me an comorbidity severity score of 43.2, while patients with sprains and strains had a low mean comorbidity score of 4.7. The DUSOI Checklist can be used in the clinical setting by both providers and auditors to produce quantitative severity scores (by diagnosis, overall, and for c omorbidity) which are based entirely upon clinical judgment. This meth od should be useful in controlling for severity of illness in clinical studies and indicating the outcome of medical care in terms of reduct ion in severity of illness following medical interventions.