Duke Severity Of Illness Checklist

Duke Severity of Illness Checklist (DUSOI) has been developed by George R. Parkerson. Original instruments have been published in English. The DUSOI is an objective measure of physical health status. The purpose of this instrument is to measure a person's illness severity. The DUSOI takes into account prognosis, medical complication level and patient symptoms for all current medical diagnoses.

Abbreviated Name: DUSOI

Purpose: To measure a person's illness severity

Population: Adult

Age Range : 18 to 96 years

Type of Instrument: Symptoms

Mode of Administration:


Time required:

Response Options: Scoring:

Score Direction: Weighting:


1 to 2 minutes for medical providers

2 to 3 minutes for medical record auditors Yes/No and 3-point Likert scale Global score

Scores by dimension Scores by items Lower scores show better QoL Yes

Number of Items: 4 for each diagnosis Original Language: English

Existing Translations : Dutch, French, German and Norwegian

Copyright: 1996-2003, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA

Contact for information and permission to use:

Professor George R Parkerson, Jr., MD, MPH Box 2914 Duke University Medical Center Durham, North Carolina 27710, USA Phone: (919) 681-3043 Fax:(919)-684-8675 Email: [email protected]

Dimensions covered by the questionnaire :

• Complications (5 items)

• Overall severity (20 items)

Key References:

1. Parkerson GR Jr, Hammond WE, Yarnall KSH. Feasibility and Potential Clinical Usefulness of a Computerized Severity of Illness Measure. Archives of Family Medicine 1994;3(11):968-973

Objective: To assess the feasibility and potential clinical usefulness of the computerized Duke Severity of Illness Checklist (DUSOI). Design: Cross-sectional study of patients whose severity of illness was measured with the DUSOI. Providers assessed the clinical usefulness of the DUSOI and recorded the length of time required for rating severity. Auditors rated severity using progress note information. Demographic and financial data from clinic records were also obtained. Setting: University-based family practice clinic with 64,621 annual visits. Patients: Convenience sample of ambulatory patients. Main Outcome Measures: Clinical usefulness and time required to rate severity. Results: For 117 patients (63.3% female; mean age, 46.3 years), the mean charge was $105.38, the mean number of health problems was 2.0, the mean overall provider DUSOI score was 33.7, and the mean auditor DUSOI score was 34.0 (scale = 0 to 100). There was excellent agreement between provider and auditor DUSOI scores (intraclass correlation coefficient, .77). Providers required 1.1 minutes to record severity; the principal auditor required 1.6 minutes. Providers found the DUSOI potentially useful in 30.3% of patients. Usefulness was greater in women (38.2% of women vs 18.2% of men), older patients (mean age, 54.5 years in useful group vs 41.9 in nonuseful group), and sicker patients (mean DUSOI score, 55.1 vs 25.9). The DUSOI was more clinically useful in patients with health problems such as type II diabetes mellitus (75.0%) than in those with problems such as tobacco use (25.0%). Higher charges correlated with a higher number of health problems and with female gender but not with severity scores. Conclusions: The computerized DUSOI is feasible for all patients and is potentially useful for women, older, and sicker patients.

2. Parkerson GR Jr, Broadhead WE, Tse CK. The Duke Severity of Illness Checklist (DUSOI) for measurement of severity and comorbidity. J Clin Epidemiol 1993;46:379-93.

The Duke Severity of Illness Checklist (DUSOI) was evaluated on 414 primary care adult patients using data collected both by medical providers at the time of the patient visit and later by a chart auditor. Severity scores for individual diagnoses were determined by summing the ratings for four non-disease-specific parameters: symptom level, complications, prognosis without treatment, and expected response to treatment. Mean diagnosis severity scores (scale 0-100) among the 21 most prevalent diagnoses varied from a low of 13.9 for menopausal syndrome to a high of 43.0 for sprains and strains. An overall severity score was calculated by combining diagnosis severity scores and giving highest weights to the most severe diagnoses. Provider-generated overall severity scores (mean = 43.3) and auditor-generated overall severity scores (mean = 38.9) were significantly correlated (coefficient of agreement = 0.59, p < 0.0001). Diagnoses varied in their individual contribution to the overall severity score, from 8.9% for lipid disorder to 90.0% for sprains and strains. Separate comorbidity severity scores were calculated to measure the severity of all of each patient's health problems except the diagnosis under study. For example, patients with menopausal syndrome had co-existing health problems which generated a high mean comorbidity severity score of 43.2, while patients with sprains and strains had a low mean comorbidity score of 4.7. The DUSOI Checklist can be used in the clinical setting by both providers and auditors to produce quantitative severity scores (by diagnosis, overall, and for comorbidity) which are based entirely upon clinical judgment. This method should be useful in controlling for severity of illness in clinical studies and indicating the outcome of medical care in terms of reduction in severity of illness following medical interventions.

3. Parkerson GR Jr, Broadhead WE, Tse C-KJ. Quality of Life and Functional Health of Primary Care Patients. Journal of Clinical Epidemiology 1992;45(11): 1303-1313.

Quality of life and functional health were measured cross-sectionally for 314 adult ambulatory primary care patients in a rural clinic and found to be much better for patients with low severity of illness who required no confinement to home because of health problems, than for patients with high severity of illness who required confinement. Severity of illness was the strongest predictor for patient-reported physical health function and for patient quality of life when assessed by the health provider. Confinement was the strongest predictor for patient quality of life when assessed by the patient. There was very little agreement between patient-assessed and provider-assessed quality of life. Family stress was the strongest predictor of function in terms of mental health, social health, general health, self-esteem, anxiety, and depression. These data suggest that clinicians should direct increased attention to patient-assessed quality of life, patient-reported functional health status, and psychosocial factors such as family stress in an effort to improve medical outcomes.

4. Parkerson GR Jr, Michener JL, Wu LR, Finch JN, Muhlbaier LH, Magruder-Habib K, Kertesz JW, Clapp-Channing N, Morrow DS, Chen A L-T, Jokerst E. Associations Among Family Support, Family Stress, and Personal Functional Health Status. Journal of Clinical Epidemiology 1989;42(3):217-229.

The self-reported family support and stress of 249 ambulatory adult patients, aged 18-49 years, were studied relative to their self-reported functional health. Support from family members was found to be related positively with emotional function. Stress from family members was associated negatively with symptom status, physical function, and emotional function. Patients' severity of illness was related negatively to their symptom status, physical function, and social function, but not to their emotional function. During the study a new self-report instrument, the Duke Social Support and Stress Scale (DUSOCS), was developed to measure family and non-family support and stress. Also, a new chart audit methodology, the Duke Severity of Illness Scale (DUSOI), was designed to assess severity in the ambulatory setting. Reliability and validity of the DUSOCS and the DUSOI were supported. The importance of the patient's perception of health and its family determinants is emphasized.

Family Support Scale Julkunen
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