68
small “plan-do-study-act” cycles (Fig. 3.4 ), rather than a grand “defi nitive” research
design. At least 20 cycles of changes in the HAQ, initially as a modifi ed HAQ
(MHAQ) reported in 1983 [ 67 ], and ultimately as a multidimensional HAQ
(MDHAQ) reported in 1999 [ 51 ] and 2005 [ 52 ], can be identifi ed (Fig. 3.5 ).
Fig. 3.4 Four stages of
Continuous Quality
Improvement (CQI)
cycles: plan, do, study, act
Fig. 3.5 Development of multidimensional health assessment questionnaire (MDHAQ) over
25 years as a continuous quality improvement (CQI) activity: HAQ Health Assessment
Questionnaire, MHAQ modifi ed HAQ, RAPID Routine Assessment of Patient Index
T. Pincus et al.