SEVERITY MEASUREMENT USING A GENERIC INSTRUMENT - A FEASIBILITY STUDYIN AMBULATORY CARE INVOLVING PATIENTS WITH DIABETES OR ASTHMA

The object of the study was to assess the performance of a generic sev erity measure [the Duke severity of illness (DUSOI) scale) in ambulato ry care in the UK, This was done in 2 settings. First, all 181 patient s with non-insulin-requiring diabetes mellitus attending a single gene ral practice had 4 retrospective ratings of severity of illness, 2 bef ore and 2 after training of the rater, Secondly, a convenience sample of 232 patients with non-insulin-requiring diabetes mellitus and 376 p atients with asthma from 57 general practices and 7 hospitals in the n orth of England had a single rating of severity of illness and complet ed a questionnaire on functional health status, From the first setting we estimated the test-retest reliability of the rating of severity: t he intraclass correlation coefficient for the 2 ratings before trainin g was 0.72 and after it was 0.85, Training increased diagnosis identif ication by 0.91 (95% CI: 0.72-1.1) diagnoses per patient, From the sec ond setting we estimated the concurrent validity of the DUSOI scale as assessed by correlation with the functional health status measures, F or 42% of patients with diabetes their diabetes was rated as their mos t severe diagnosis; for 85% of patients with asthma their asthma was r ated as their most severe diagnosis, For patients with asthma the DUSO I scores correlated with physical health domains. For patients with di abetes similar correlations were much weaker, We conclude that the DUS OI scale is capable of reliable use and has concurrent validity, Howev er, it requires further evaluation to fully establish its utility in U K ambulatory care.