Measuring Signs of Atopic Dermatitis in Clinical Practice: A HOME-CP Consensus Statement

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Michael E. Jacobson - , Oregon Health and Science University (First author)
  • Yael A. Leshem - , Rabin Medical Center Israel, Tel Aviv University (Author)
  • Christian Apfelbacher - , Otto von Guericke University Magdeburg, Nanyang Technological University (Author)
  • Phyllis I. Spuls - , University of Amsterdam (Author)
  • Louise A.A. Gerbens - , University of Amsterdam (Author)
  • Kim S. Thomas - , University of Nottingham (Author)
  • Hywel C. Williams - , University of Nottingham (Author)
  • Norito Katoh - , Kyoto Prefectural University of Medicine (Author)
  • Laura Howells - , University of Nottingham (Author)
  • Jochen Schmitt - , Center for Evidence-Based Healthcare (Author)
  • Stefanie Deckert - , Center for Evidence-Based Healthcare (Author)
  • Rishi Seshadri - , Oregon Health and Science University (Author)
  • Eric L. Simpson - , Oregon Health and Science University (Last author)

Abstract

Importance: Outcome measurement is an essential component of value-based health care and can aid patient care, quality improvement, and clinical effectiveness evidence generation. The Harmonising Outcome Measures for Eczema Clinical Practice initiative aims to identify a list of validated, feasible, outcome measurement instruments recommended to measure atopic dermatitis (AD) in the clinical practice setting. The clinical practice set is a list of instruments that clinicians can pick and choose from to suit their needs in the context of clinical care. Objective: To recommend instruments to measure clinical signs of AD in clinical practice. Evidence Review: Following the predefined roadmap, a mixed methods design was implemented and incorporated systematic reviews and qualitative consensus methods. Previous systematic reviews identified few clinical signs instruments with sufficient validation for recommendation. An updated systematic review evaluating the validity of clinical signs instruments informed an international meeting to reach consensus on recommended instruments to measure AD clinical signs in clinical practice. Consensus was defined as less than 30% disagreement. An in-person consensus exercise was held in Montreal, Canada, on October 16, 2022. The 34 attendees included patient and patient advocate research partners, health care professionals, researchers, methodologists, and industry representatives. Findings: The updated systematic review found that the Eczema Area and Severity Index (EASI), Scoring Atopic Dermatitis, and objective Scoring Atopic Dermatitis were the only instruments that demonstrated sufficient performance in all assessed measurement properties. The modified EASI and Signs Global Assessment × Body Surface Area instruments were also recommended. The EASI, Validated Investigator Global Assessment, and Investigator's Global Assessment multiplied by or measured concurrently with a body surface area measure achieved consensus in criteria and were adopted. Conclusions and Relevance: This consensus statement by the Harmonising Outcome Measures for Eczema initiative suggests that when assessing and documenting clinical signs of AD, there are several valid and feasible instruments that can best fit a clinician's specific practice needs. These instruments should improve and standardize the documentation of signs severity, help determine the effect of treatment, facilitate the generation of clinical effectiveness evidence, and enhance the implementation of value-based health care.

Details

Original languageEnglish
Pages (from-to)878-886
Number of pages9
JournalJAMA dermatology
Volume160
Issue number8
Publication statusPublished - 21 Aug 2024
Peer-reviewedYes

External IDs

PubMed 38776110

Keywords

ASJC Scopus subject areas