Pincus Theodore, Castrejón Isabel
Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, New York 100003, USA.
Bull NYU Hosp Jt Dis. 2012;70(2):73-94.
An evidence-based visit is described based on quantitative, standard scientific data on two simple forms for a patient and a physician. The focus is rheumatoid arthritis (RA), but the principles may be applied to most rheumatic and chronic diseases. A quantitative patient history is recorded on a selfreport multidimensional health assessment questionnaire (MDHAQ), which includes scales for physical function, pain, patient global estimate, psychological distress, change in status, exercise status, morning stiffness, fatigue, and a template to score RAPID3 (routine assessment of patient index data 3). RAPID3, an index of only patient self-report measures, distinguishes active from control treatments in clinical trials at similar levels to a disease activity score (DAS28) and clinical disease activity index (CDAI) but is calculated in 5 seconds, compared to almost 2 minutes for DAS28 or CDAI. The MDHAQ also includes traditional "medical" matters-a self-report joint count, review of systems, recent medical history, medications, demographic data, and consents for future monitoring by mail and sharing data with research colleagues; these queries enhance acceptance by patients and save time for doctors. Patient questionnaire physical function scores-not radiographs or laboratory tests-are the most significant prognostic markers for long-term work disability and premature death in RA. The physician completes a "doctor evaluation" (DOCEVAL) form, which includes four visual analog scales for overall status, inflammation, damage, and "neither" (usually fibromyalgia), reflecting quantitatively the expertise of a rheumatologist to classify the etiology of pain and distress into one of these three broad categories in formulating a treatment plan. Quantitative data from patients and doctors on an evidence-based visit can advance rheumatology clinical care and clinical science.
基于针对患者和医生的两种简单表格的定量、标准科学数据，描述了一种循证问诊方式。重点是类风湿关节炎（RA），但这些原则可应用于大多数风湿性和慢性疾病。通过一份自我报告的多维健康评估问卷（MDHAQ）记录定量的患者病史，该问卷包括身体功能、疼痛、患者整体评估、心理困扰、状态变化、运动状态、晨僵、疲劳等量表，以及一个用于对RAPID3（患者指数数据的常规评估3）进行评分的模板。RAPID3仅基于患者自我报告测量指标，在临床试验中区分活性治疗与对照治疗的水平与疾病活动评分（DAS28）和临床疾病活动指数（CDAI）相似，但计算时间为5秒，而DAS28或CDAI则需要近2分钟。MDHAQ还包括传统的“医疗”事项——自我报告的关节计数、系统回顾、近期病史、用药情况、人口统计学数据，以及同意通过邮件进行未来监测并与研究同事共享数据；这些询问提高了患者的接受度，并为医生节省了时间。患者问卷中的身体功能评分——而非X光片或实验室检查——是RA患者长期工作残疾和过早死亡的最重要预后指标。医生完成一份“医生评估”（DOCEVAL）表格，其中包括四个视觉模拟量表，分别用于评估总体状况、炎症、损伤和“非上述情况”（通常为纤维肌痛），在制定治疗计划时，定量反映风湿病学家将疼痛和困扰的病因归类为这三大类之一的专业能力。患者和医生在循证问诊中提供的定量数据可以推动风湿病临床护理和临床科学的发展。
