Impact of monitoring health-related quality oflife in clinical practice in children with type 1 diabetes mellitus.

Abstract

To test whether the systematic monitoring of health-related quality of life (HRQOL) in clinical practice in Spanish pediatric patients with T1DM helps improve their daily life in a multicenter longitudinal study. One hundred thirty-six patients participated, recruited from five centers in Barcelona, Spain (72 girls, mean age 13.4years). Complete data were collected for 119 patients (85%). Pediatricians were randomly assigned to the HRQOL intervention (n=70), or control group (n=49). The intervention group discussed the results of HRQOL face to face with the physician, quarterly over a year. The control group received care as usual. HRQOL was assessed using KIDSCREEN-27 collected online. Standardized mean differences (effect size, ES) and generalized estimating equation (GEE) were computed to compare group differences between baseline and follow-up, taking into account sociodemographic and clinical variables. Statistically significant higher scores were seen in the intervention group at follow-up for the dimensions of Psychological well-being (ES=0.56), School environment (ES=0.56), and the KIDSCREEN-10 index (ES=0.63). No differences were found in the control group. GEE analysis showed an improvement in HRQOL at follow-up with statistically significant association of the intervention on Psychological well-being (B=4.32; p 0.03 for the interaction of group by follow-up) and School environment (B=4.64; p 0.02 for the same interaction term). Routine assessment and face-to-face patient-physician discussion of HRQOL results improved HRQOL scores after a year of follow-up, especially in Psychological well-being and school environment. The results support the routinary use of HRQOL assessment in clinical practice.