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

风湿病学界已经认识到， 关节炎自我保健教育的临床和经济学评价 患者促进公共政策审议关于适当的第三- 缔约方偿还或其他融资机制。 虽然结果 对临床疗效的研究表明，适度的，但临床上重要的， 关节炎患者教育的结果，相对较少的研究 骨关节炎（OA）。 没有全面评估经济 效益或成本效益存在于文献中。 这样做的目的 研究将评估，相对于注意力安慰剂， 膝关节骨性关节炎患者的个体化自我护理教育 残疾、疼痛、卫生保健利用和费用以及生活质量。 此外，我们将把医疗保健利用率、成本和 生活质量的措施，以估计质量调整生命年 通过患者教育获得（或节省），以及成本效益 (i.e.,自我保健教育的成本效用。 本研究中的受试者将 368例特发性或创伤后膝关节OA患者。 受试者将从印第安纳州的主要初级保健实践中招募 大学医学中心和社区医生。 受试者将 随机分配到实验（E）和对照（C）处理 条件 在基线时，受试者将接受病史和体格检查。 检查、教育、功能状态、疼痛和生活质量 评估。 受试者还将记录所有自付OA 费用 受试者将接受一个疗程的个性化关节炎治疗 来自关节炎护士教育者的自我护理指导。 C主题视图a 一般关节炎幻灯片磁带介绍。 我们还将控制 印刷参考材料和后续联系。 受试者将 继续从他们的初级保健接受持续的关节炎护理 医生 对于每例受试者，后续研究评估将在 四个月间隔一年（即，4、8和12个月 干预后）。 所有干预后评估将由 一个“盲人”研究助理，并将包括一个并发的历史，和 重复给予功能状态、疼痛和生活质量 措施 将收集受试者日记，并在下次 将发行四个月（第12个月除外）。 在最终（12个月） 评估，教育诊断评估也将重复。 临床效应的统计分析将包括组间比较 关于残疾、疼痛和生活质量量表。 保健 利用率和相关费用也将进行比较。 使用连续测量 在幸福质量量表中，我们将估计质量调整年数 E组和C组受试者累积的寿命（健康年）。 关节炎- 将比较两组的相关成本，以估计净经济效益 自我护理教育对膝关节OA患者的益处。 团体费用将 与相应的井年总数相关联， 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.