The International Dermatology Outcome Measures (IDEOM) group and the American Academy of Dermatology (AAD) have arrived at a consensus on the development of a valid feasible provider-assessed global disease severity metric to be incorporated into a quality measure for inflammatory dermatoses. In order to inform the modified Delphi process, a literature review was conducted and data were collected on current provider-assessed global disease severity metrics, with the results published in the Journal of the American Academy of Dermatology.

A total of 36 members from IDEOM and the AAD participated in the meeting, including  dermatologists, pediatric dermatologists, rheumatologist-dermatologists, quality measures experts, members of the AAD, a patient, and a research fellow.

It is well known that an urgent need exists for the dermatology community to develop a disease severity metric with the ability to demonstrate the high-quality care delivered to patients with severe dermatologic diseases. This metric will be the initial step toward a quality measure in the field of dermatology — one that is both feasible in clinical practice and used in published guidelines by professional dermatology organizations. The metric must be quantifiable and resemble a diagnostic test, such as the hemoglobin A1C test.

The consensus participants voted on 2 fundamental metric features: (1) inflammatory dermatoses to be included in the global measure, and (2) quantification of the global assessment tool. With respect to the first metric feature, the collaborators voted on which inflammatory skin disorders of among 23 commonly encountered in dermatology practices should be included in the global disease severity metric. After a review and discussion, the participants had to priority rank six of the inflammatory skin diseases that had achieved almost overwhelming consensus (ie, ≥90%) in the first Delphi round. Regarding the second metric feature, the collaborators voted on which of 4 potential types of scales should be used to quantify the global disease severity metric.

Atopic dermatitis, psoriasis, and acne attained overwhelming consensus for inflammatory skin disorders that could be measured with the utilization of a global disease severity metric. The members also reached consensus on the use of a 5-point ordinal scale with descriptors provided via referenced electronic platforms.

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The investigators concluded that expert development of quality measures that incorporate this metric and its inclusion in data collection platforms are key to allowing dermatologists to prove the value of care they provide to their patients with severe inflammatory dermatoses. Future cooperation between IDEOM and the AAD will focus on the development of quality measures that support, incentivize, and incorporate the use of this proposed provider-global disease severity metric.

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Reference

International Dermatology Outcome Measures and the American Academy of Dermatology; Gottlieb A, Salame N, Armstrong AW, et al. A provider global assessment quality measure for clinical practice for inflammatory skin disorders [published online September 19, 2018]. J Am Acad Dermatol. doi:10.1016/j.jaad.2018.09.017