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Improving Patient Function: A Randomized Trial of Functional Disability Screening

Lisa V. Rubenstein, MD; David R. Calkins, MD; Roy T. Young, MD; Paul D. Cleary, MD; Arlene Fink, PhD; Jacqueline Kosecoff, PhD; Alan M. Jette, PhD; Allyson R. Davies, PhD; Thomas L. Delbanco, MD; and Robert H. Brook, MD, ScD
[+] Article, Author, and Disclosure Information

Grant Support: Supported by the Robert Wood Johnson Foundation, Princeton, New Jersey. The views expressed herein are those of the authors and not necessarily those of the Foundation.

Requests for Reprints: Lisa Rubenstein, MD, Department of Medicine, UCLA Center for Health Sciences, Los Angeles, CA 90024.

Current Author Addresses: Drs. Rubenstein, Young, and Brook: Department of Medicine, UCLA Center for Health Sciences, Los Angeles, CA 90024.

Drs. Calkins and Delbanco: Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215.

Dr. Cleary: Department of Health Care Policy, Harvard Medical School, 255 Shattuck Street, Parcel B, 1st Floor, Boston, MA 02115.

Drs. Fink and Kosecoff: 1535 6th Street, Suite 205, Santa Monica, CA 90401.

Dr. Jette: New England Research Institute, 9 Galen Street, Watertown, MA 02122.

Dr. Davies: Department of Quality Assessment, New England Medical Center, Box 100, 750 Washington Street, Boston, MA 02111.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;111(10):836-842. doi:10.7326/0003-4819-111-10-836
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Study Objectives: To test whether a 34-item functional status questionnaire measuring physical, psychological, and social function can be used by physicians in practice to help improve their patients' outcomes.

Design: Prospective randomized trial.

Setting: Community internal medicine practices.

Patients: Five hundred and ten continuing patients with functional disabilities who saw their physicians at least four times a year.

Physicians: Seventy-six UCLA clinical volunteer faculty who are internists in community office practices.

Interventions: Physicians and their patients were randomly assigned to the experimental or the control group. Experimental group physicians attended a 2-hour multimedia educational session and received four functional status reports on each of their study patients over a 1-year period. Control group physicians received no education and no functional status feedback. Control group and experimental group patients were tested for functional status with the functional status questionnaire every 4 months for 1 year. Both groups also completed monthly diaries that measured use of health services. Experimental group physicians answered an anonymous evaluation questionnaire at 6 months after study entry.

Measurements and Main Results: Forty-three percent of experimental group physicians reported that they had used the functional status questionnaire to change therapy. Ninety-five percent reported that it was useful and accurate. Patient diaries did not show any difference between experimental group patients and control group patients in number of medications used, visits to physicians or other health professionals, equipment purchased, diet, or exercise programs. There were no significant differences between experimental and control group patients at exit from the study on any functional status or health outcome measure.

Conclusion: A more powerful intervention than a 2-hour educational session and the regular provision of functional status information is needed to help office-based internists improve patient outcomes.





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