Feasibility and potential clinical usefulness of a computerized severity of illness measure.

OBJECTIVE

To assess the feasibility and potential clinical usefulness of the computerized Duke Severity of Illness Checklist (DUSOI).

DESIGN

Cross-sectional study of patients whose severity of illness was measured with the DUSOI. Providers assessed the clinical usefulness of the DUSOI and recorded the length of time required for rating severity. Auditors rated severity using progress note information. Demographic and financial data from clinic records were also obtained.

SETTING

University-based family practice clinic with 64,621 annual visits.

PATIENTS

Convenience sample of ambulatory patients.

MAIN OUTCOME MEASURES

Clinical usefulness and time required to rate severity.

RESULTS

For 117 patients (63.3% female; mean age, 46.3 years), the mean charge was $105.38, the mean number of health problems was 2.0, the mean overall provider DUSOI score was 33.7, and the mean auditor DUSOI score was 34.0 (scale = 0 to 100). There was excellent agreement between provider and auditor DUSOI scores (intraclass correlation coefficient, .77). Providers required 1.1 minutes to record severity; the principal auditor required 1.6 minutes. Providers found the DUSOI potentially useful in 30.3% of patients. Usefulness was greater in women (38.2% of women vs 18.2% of men), older patients (mean age, 54.5 years in useful group vs 41.9 in nonuseful group), and sicker patients (mean DUSOI score, 55.1 vs 25.9). The DUSOI was more clinically useful in patients with health problems such as type II diabetes mellitus (75.0%) than in those with problems such as tobacco use (25.0%). Higher charges correlated with a higher number of health problems and with female gender but not with severity scores.

CONCLUSIONS

The computerized DUSOI is feasible for all patients and is potentially useful for women, older, and sicker patients.