Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

The risks and benefits of using the KDQOL-SF 36; a review of it's current uses, applications and mis-uses (ie/ intrepreting a correlational effect as causal, effective interventions, and if none are found, the risks and benefits of mandating professional interventions for a 10 point drop in scores between assessments, or for scores lower than average. The risk of professionals using only an average score instead of normal ranges; the effect of determining normal ranges without knowing the Standard Deviations for each variable in the DOPPS study, the appropriatness of dialyisis units developing a set of normal ranges based on scores completed from their own patients without determining correlational probability of hospitalization and death as was done in the original study.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Interventions shown to be effective in improving KDQOL-36 scores, both for patients with and without specific co-morbidities (ie/ cancer, amputations, infections)

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Dialyisis patietns

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

ESRD

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Appropriate use/applicaton/analyisis/interventions based on KDQOL-surveys.

Describe any health-related risks, side effects, or harms that you are concerned about.

Negative psychological effects of mis-interpreting scores, or use with patients with chronic, severe co-morbidities who have a poor prognosis.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Arthritis and nontraumatic joint disorders
• Cancer
• Cardiovascular disease, including stroke and hypertension
• Dementia, including Alzheimer's disease
• Depression and other mental health disorders
• Diabetes mellitus
• Functional limitations and disability
• Infectious diseases, including HIV/AIDS
• Obesity
• Peptic ulcer disease and dyspepsia
• Pulmonary disease/asthma

AHRQ Priority Populations

• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicare

Importance

Describe why this topic is important.

This tool is curently mandated by CMS, but is being broadly mis-interpreted. which vary, depending on if you are comparing against the DOPPS study, or another sample group, and if standard deviations are calculated for all variables (SD for diabetic status is significant, but copywritten and undisclosed to all but one group, which calculates scores for a cost, and has influenced CMS to mandate this tool--the were scoring for free before it became mandatory) and some providers were not comparing ranges, only a single numeric value for average scores.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

New polcies, CNSW list-serve discussions.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Is this beneficial for patients?

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Focus on effective uses and interventions.

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

I have seen patients become upset because their low scores because their is no effective intervention to improve thier scores (ie/ unable to do what they would like to do because they have cancer, severe arthritic pain or amputations...often all three!(

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Focus on effective uses and interventions.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program