The cost and efficacy of home care for patients with chronic lung disease.

A randomized controlled trial was conducted to assess efficacy and cost of sustained home nursing care for patients with chronic lung disease. Three hundred one patients were randomly assigned to a respiratory home care group (RHC) that received care from respiratory home care nurses, a standard home care group (SHC) that received care from regular home care nurses, or an office care group (OC) that received whatever care they needed except for home care. Patients were followed for 1 year. At the end of the study year, there was no difference in survival, pulmonary function, or everyday functioning among the three groups. Average annual cost of care for all study patients was $7,647 (1981-82 dollars). The average annual health care costs for patients in the RHC group was $9,768; for those in the SHC group, $8,058; and for those in the OC group, $5,051 (F = 6.45, df = 2/298, P = 0.02). These results suggest that the current policy of limited coverage of home nursing services by Medicare and other third-party payers may be appropriate.

The Sickness Impact Profile: development and final revision of a health status measure.

The final development of the Sickness Impact Profile (SIP), a behaviorally based measure of health status, is presented. A large field trial on a random sample of prepaid group practice enrollees and smaller trials on samples of patients with hyperthyroidism, rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses. Test-retest reliability (r = 0.92) and internal consistency (r - 0.94) were high. Convergent and discriminant validity was evaluated using the multitrait--multimethod technique. Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores. The relationship between the SIP and criterion measures were moderate to high and in the direction hypothesized. A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis. The final SIP contains 136 items in 12 categories. Overall, category, and dimension scores may be calculated.

A Chicano version of the Sickness Impact Profile (SIP). A health care evaluation instrument crosses the linguistic barrier.

Evaluation of improvement of access of health services requires measurement across cultural and language boundaries. Using a measure of functional health status, the Sickness Impact Profile (SIP), a procedure for and analysis of a Chicano Spanish translation of the SIP is presented. Consensus among translators was achieved. The translation was validated by administering English and Spanish versions to 31 bilinguals and by having Spanish monolinguals rescale it. In both cases, correlations between English and Spanish versions were high.

The Sickness Impact Profile: reliability of a health status measure.

This report describes the results of research conducted on the reliability of the Sickness Impact Profile (SIP). The SIP is a questionnaire instrument designed to measure sickness-related behavioral dysfunction and is being developed for use as an outcome measure in the evaluation of health care. The test-retest reliability of the SIP in terms of several reliability measures was investigated using different interviewers, forms, administration procedures, and a variety of subjects who differed in terms of type and severity of dysfunction. The results provided evidence for the feasibility of collecting reliable data using the SIP under these various conditions. In addition, subject variability in relation to reliability is discussed.

The sickness impact profile: validation of a health status measure.

The Sickness Impact Profile (SIP), a measure of health status, is being developed as an outcome measure of health care. A preliminary study of the validity of the SIP was conducted on a sample of 278 subjects who were grouped into four subsamples differing in kind and severity of sickness. Selfassessment of health status, clinician assessment of health status, and other measures of dysfunction were used as criteria. SIP scores discriminated among subsamples, and correlations between criterion measures and SIP scores provided evidence for the validity of the SIP. Differences among the correlations obtained for each criterion measure with SIP score are discussed in terms of the need for the development of criterion measures that can be expected to differentially relate to the constructs inherent in the SIP.

Validation of an interval scaling: the sickness impact profile.

The Sickness Impact Profile (SIP) is a measure of sickness-related behavioral dysfunction consisting of 189 items in 14 topic categories. To increase its discrimination, precision, and sensitivity in accounting for variance, the decision was made to scale the instrument. A two-step direct scaling procedure was used in order to avoid the monumental scaling tasks required by indirect procedures that guarantee equal-interval results; but because an equal-interval scale was needed, it was necessary to validate the scale values obtained and investigated the equal-intervval properties of the obtained scale. A three-stage validation process is described, consisting of an initial scaling by a group of 25 health professionals and students in 1973, a second scaling by 108 members of a prepaid group health plan in 1975, and an investigation of the metric properties of the resulting scale values. In addition, the concept of dysfunction underlying the SIP was validated. SIP scores from a field trial were compared with mean ratings of severity of dysfunction represented by the combinations of checked items from which the scores were derived.

The sickness impact profile: conceptual formulation and methodology for the development of a health status measure.

The development of a health status measure, the Sickness Impact Profile (SIP), is described in terms of both its conceptualization and methodology. The need for a health status measure that is sensitive and appropriate, based on sickness-related behavior, and culturally unbiased, is discussed. A model of sickness behavior is presented as a guide for methodological development. The description of the initial developmental stage of the SIP includeds detailed discussion and documentation of the collection, sorting and grouping of items that comprise the SIP, scaling of the items, scoring of the instrument, and testing and revision of the prototype instrument. Results of preliminary tests of reliability, validity, and administrative feasibility are presented. Subsequent steps in revision and finalization, now under way, are outlined.