Measuring Patient and Clinician Perspectives to Evaluate Change in Health-Related Quality of Life Among Patients with Chronic Obstructive Pulmonary Disease

CONTEXT: Many treatments aim to improve patients’ health-related quality of life (HRQoL), and many care guidelines suggest assessing symptoms and their impact on HRQoL. However, there is a lack of consensus regarding which HRQoL outcome measures are appropriate to assess, and how much change on those measures depict significant HRQoL improvement. OBJECTIVE: We used triangulation methods to identify and understand clinically important differences (CIDs) for the amount of change in HRQoL that reflects both health professionals and patients’ values, among patients with chronic obstructive pulmonary disease (COPD). DESIGN, SETTING, AND PARTICIPANTS: We incorporated three perspectives: (1) an expert panel of physicians familiar with the measurement of HRQoL in COPD patients; (2) 610 primary care COPD outpatients who completed baseline and bimonthly follow-up HRQoL interviews over the 12-month study; and (3) the primary care physicians (PCPs; n = 43) of these outpatients who assessed their patients’ disease at baseline and at subsequent PCP visits during the year long study. MEASUREMENTS: The Chronic Respiratory Disease Questionnaire (CRQ), the Medical Outcomes Study Short Form 36-item survey (SF-36, version 2.0), and global assessments of change from each of the three perspectives for all HRQoL domains. RESULTS: With few exceptions, the CRQ was able to detect small changes at levels reported by the patients (1–2 points) and their PCPs (1–5 points). These results confirm minimal important difference standards developed in 1989 by Jaeschke et al. anchored on patient-perceived changes in HRQoL. In general, the expert panel and PCP CIDs were larger than the patient CIDs. CONCLUSION: This triangulation methodology yielded improved interpretation, understanding, and insights on stakeholder perspectives of CIDs for patient-reported outcomes

Role playing to train elementary teachers to use a classroom management “skill package”

Two teachers who led regular third-grade classrooms in a suburban elementary school were trained via role-playing to use a broad range of social skills in dealing with group behavioral management in the classroom. Teacher training reduced disruptive student behavior during both seat work and group discussions in both classrooms. A measure of student productivity during arithmetic period in one classroom showed significant gains in arithmetic problems correct per day for the middle and bottom thirds of the class, with the bottom third increasing by 76%

Pyramid training of elementary school teachers to use a classroom management “skill package”

Three regular elementary teachers were trained in the use of a classroom management “skill package”. Subsequently, each of these three teachers (tier 1 of training) trained three more teachers to use the same skill package (tier 2 of training). Direct behavioral measures of student disruptiveness were taken in the three tier-1 classrooms and four tier-2 classrooms, and permanent product measures of student productivity in arithmetic were taken in the three tier-1 classrooms. Results indicated that student disruptiveness decreased at least as much in the tier-2 classrooms as in the tier-1 classrooms. Data also indicated that serving as trainers benefited two of the tier-1 teachers who profited least from the original training by producing further reductions in disruptiveness in their respective classrooms. Productivity data suggested that use of the “skill package” increased classroom academic output, especially for those students below the median in productivity during baseline. The investigators' time investment in training a tier-2 teacher was one-fourth that of training a tier-1 teacher