EVALUATION OF CLINICAL/ECONOMIC FACTORS ON PATIENT EDUCATION FOR OA OF THE KNEE

风湿病界已经认识到有必要从 关节炎自我护理教育的临床与经济学评价 患者推动公共政策审议适当的第三方- 一方报销或其他融资机制。虽然结果是 对临床疗效的研究表明，虽然有限，但临床上很重要， 关节炎患者教育的结果，相对较少的研究 专注于骨关节炎(OA)。没有对经济状况进行全面评估 效益或成本效益存在于文献中。这样做的目的是 研究将评估，相对于注意力安慰剂， 膝骨性关节炎患者的个体化自我护理教育 残疾、疼痛、卫生保健利用和成本，以及生活质量。 此外，我们将把卫生保健利用率、成本和 生活质量测量，以估算经质量调整的生命年 通过患者教育获得(或节省)，以及成本效益 (即成本效用)的自我照顾教育。这项研究的受试者将 368例特发性或创伤后膝骨性关节炎患者。 受试者将从印第安纳州主要的初级保健诊所招募 大学医学中心和社区医生。主题将是 随机分配到试验组(E)和对照组(C) 条件。在基线上，受试者将接受病史和体检 检查、教育、功能状态、疼痛和生活质量 评估。受试者还将保留所有自掏腰包的办公自动化的日记 费用。受试者将接受个性化的关节炎疗程。 一位关节炎护士教育者的自我护理指导。C主题查看a 全面性关节炎幻灯片演示。我们还将控制 印刷的参考资料和后续联系。研究对象将 继续从他们的初级保健中接受持续的关节炎护理 医生。对于每个科目，后续的学习评估将在 间隔四个月，为期一年(即4、8和12个月 干预后)。所有干预后评估将由 “盲人”研究助理，并将包括同时发生的历史，以及 重复给予功能状态、疼痛和生活质量的治疗 措施。将收集主题日记，并为下一期收集新的日记 将发行四个月的债券(第十二个月除外)。在决赛期间(12个月) 评估方面，教育诊断评估也将重复进行。 临床效果的统计分析将包括分组比较 关于残疾、疼痛和生活质量量表。医疗保健 使用率和相关成本也将进行比较。使用系列措施 关于质量幸福感的规模，我们将估计质量调整后的年份 E组和C组受试者累积的寿命(良好年数)关节炎- 两组的相关成本将进行比较，以估计净经济 自我护理教育对膝骨性关节炎患者的益处。集团成本将 与相应的井年总数相关，以产生估计 成本效用。

The rheumatology community has recognized the need for results from clinical and economic evaluations of self-care education for arthritis patients to promote public policy deliberations about appropriate third- party reimbursement or other financing mechanisms. While results of research on clinical efficacy suggest modest, but clinically important, outcomes of arthritic patient education, relatively few studies have focussed on osteoarthritis (OA). No thorough evaluations of economic benefit or cost-effectiveness exist in the literature. The purpose of this study will be to evaluate, relative to attention placebo, the effects of individualized self-care education for patients with OA of the knee on disability, pain, health care utilization and costs, and quality of life. Furthermore, we will interrelate health care utilization, costs, and quality of life measures so as to estimate quality-adjusted life years gained (or saved) by patient education, as well as cost-effectiveness (i.e., cost-utility) of self-care education. Subjects in this study will be 368 patients with either idiopathic or post-traumatic OA of the knee. Subjects will be recruited from major primary care practices of the Indiana University Medical Center and from community physicians. Subjects will be allocated at random to Experimental (E) and Control (C) treatment conditions. At baseline, subjects will receive a history and physical examination, and educational, functional status, pain and quality of life assessments. Subjects also will keep a diary of all out- of-pocket OA expenses. E subjects will receive a course of individualized arthritis self-care instruction from an arthritis nurse educator. C subjects view a general arthritis slide tape presentation. We also will control for printed reference materials and for follow-up contact. Subjects will continue to receive ongoing arthritis care from their primary care physicians. For each subject, subsequent study assessment will occur at four-month intervals for a period of one year (i.e., 4, 8, and 12 months postintervention). All postintervention assessments will be conducted by a "blind" research associate and will include an intercurrent history, and repeat administrations of the functional status, pain, and quality of life measures. Subject diaries will be collected and new diaries for the next four months will be issued (except month 12). During the final (12-month) assessment, the educational diagnostic assessment also will be repeated. Statistical analysis of clinical effects will include group comparisons with respect to disability, pain, and quality of life scales. Health care utilization and related costs also will be compared. Using serial measures of the Quality of Well Being Scale, we will estimate quality-adjusted years of life (well years) accumulated by subjects in Groups E and C. Arthritis- related costs in the two groups will be compared to estimate net economic benefit of self-care education for patients with knee OA. Group costs will be related to corresponding totals of well years to produce estimates of cost-utility.