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May 2013

Standardizing Training for Psoriasis Measures: Effectiveness of an Online Training Video on Psoriasis Area and Severity Index Assessment by Physician and Patient Raters

Author Affiliations

Author Affiliations: Department of Dermatology, University of California, Davis, Sacramento (Drs Armstrong, Parsi, and Schupp); Division of Rheumatology, Department of Medicine, University of Washington, Seattle (Dr Mease); and Department of Dermatology, University of Utah, Salt Lake City (Dr Duffin).

JAMA Dermatol. 2013;149(5):577-582. doi:10.1001/jamadermatol.2013.1083

Importance Because the Psoriasis Area and Severity Index (PASI) is the most commonly used and validated disease severity measure for clinical trials, it is imperative to standardize training to ensure reliability in PASI scoring for accurate assessment of disease severity.

Objective To evaluate whether an online PASI training video improves scoring accuracy among patients with psoriasis and physicians on first exposure to PASI.

Design This equivalency study compared PASI assessment performed by patients and PASI-naive physicians with that of PASI-experienced physicians at baseline and after standardized video training. The study was conducted from March 15, 2011, to September 1, 2011.

Setting Outpatient psoriasis clinic at University of California, Davis.

Participants Forty-two psoriasis patients and 14 PASI-naive physicians participated in the study. The scores from 12 dermatologists experienced in PASI evaluation were used as the criterion standard against which other scores were compared.

Main Outcome Measures Aggregate and component PASI scores from image sets corresponding to mild, moderate, and severe psoriasis.

Results After viewing the training video, PASI-naive physicians produced equivalent scores for all components of PASI; patients provided equivalent scores for most PASI components, with the exception of area scores for moderate-to-severe psoriasis images. After the online video training, the PASI-naive physicians and patients exhibited improved accuracy in assigning total PASI scores for mild (Meanexperienced physician − MeanPASI-naive physician: 1.2; Meanexperienced physician − Meanpatient: −2.1), moderate (Meanexperienced physician − MeanPASI-naive physician:0; Meanexperienced physician − Meanpatient: −5.7), and severe (Meanexperienced physician − MeanPASI-naive physician: −5.1; Meanexperienced physician − Meanpatient: −10.4) psoriasis, respectively.

Conclusions and Relevance Use of an online PASI training video represents an effective tool in improving accuracy in PASI scoring by both health care professionals and patients. The video-based online platform for disseminating standardized training on the use of validated instruments in dermatology represents a novel form of standardized education.