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protocol- driven format. Therefore, most intake questionnaires remain “subjective”
and “nonscientifi c” (Table 3.2 ). A patient who is seen by different health profes-
sionals often is asked to complete new intake questionnaires, although 50 % or more
of the information is redundant with previously completed questionnaires.
The 4-page version of the MDHAQ (Appendix B) for an initial patient visit (or
initial entry into a database) includes medical history information for entry into a
medical database for a medical record. This version includes scales for physical
function, pain, global status, RAPID3, fatigue, self-report joint count, review of
systems, exercise, change in status, morning stiffness, recent medical history, and
demographic data found on the 2-page MDHAQ (Appendix A). In addition, a
4-page (2 sheets of paper) version includes elements of a standard medical history:
previous illnesses, surgeries, hospitalizations, allergies to medications and other
substances, family history, social history, and current medications.
The 4-page MDHAQ also includes a request for two patient consents, in addition
to usual consents asked of new patients:
- to share de-identifi ed data beyond the patient’s physician with a few selected
research colleagues designated by the attending physician, for possible collab-
Table 3.8 Pragmatic advantages of MDHAQ/RAPID3
A Pragmatic advantages of MDHAQ/RAPID3 to the patient
1 Helps prepare the patient for encounter by focusing on concerns to discuss with the doctor
2 Empowers patient as partner in care
3 Improves doctor–patient communication—”agenda” or “road map” available for both
before encounter
B Pragmatic advantages of MDHAQ/RAPID3 to the doctor
1 The patient does almost all the work
2 Does not disrupt offi ce fl ow or require any time and effort from the doctor, when presented
to each patient for completion at each visit as part of the infrastructure of care
3 MDHAQ saves time for the doctor, providing a 10–15 s overview of medical history data
that would otherwise require about 10–15 min of conversation, including a self-report joint
count, review of systems, recent medical history
4 RAPID3 is scored in 5 s, compared to 40 s for a HAQ, 90–95 s for a formal joint count,
104 s for a CDAI, and 116 s for a DAS28
5 RAPID3 levels for high, moderate, and low severity, and remission, can be used effectively
for treat-to-target in RA
6 More reproducible than joint counts or radiographic scores, as there is only one observer
(the patient): does not require the same examiner at each assessment, unlike joint count or
radiographic score
7 Ensures that quantitative data concerning patient status is recorded at every visit, even if
joint count or physician global not preformed and/or lab test is not available
8 Informative in most, if not all, rheumatic diseases—also included in scientifi c advantagesT. Pincus et al.