minimal clincially important difference

minimal clincially important difference invented

• researched realized a treatment can produce a statistically significant, very small change, and patients cannot feel it

• this asks: can the patient actually tell the difference

MCID depends on

• disease, outcome, instrument, patient population, severity, sometimes even direction (improvement vs worsening)

outcome measures

• MCID belongs to _____

minimal clincially important difference (MCID)

• the smallest change in a treatment outcome that a patient would identify as important, either beneficial or harmful and which would lead the patient or clinician to consider a change in the management

disribition, anchor

• methods by which minimal clincially important difference can be dervied

distribution based MCID method

• what does the math suggest?

• use the frequency distribution of observed events, and 0.5 SD and 1 SEM have been suggested

• provides a value that indicates a statistical difference, but this may not be perceivable by a patient or clinician

anchored based MCID methods

• what do patients actually notice

• examine the relationship between scores on the assessment instrument and other measures of impaired health

estimation of MCID

• should be based on multiple approaches, with the resulting values narrowed down to a single value or small range. based on a process of triangulation

• average estimates obtained in groups of patients

MCID vs MID

• most published literature uses MCID, newer QOL literature often prefers MID

• because MCID focuses attention on the clinical arena rather than patients’ experiences in their day to day lives, clinical interpretation was removed, so MID is more patient oreinted

• often MCID and MID are used interchangeabley, just note who is noting any differences

HRQOL

• patient important outcome because it is the patients who expereince their own, and only they are in the positioin to ulitmately judge whether a difference is important

MID

• readers of research must attend to who rated the importance of an HRQOL change and the specific instructions provided for making the assessment

• the first choice for establishing the MID should be a patient centered approach

• relative to patients, clinicians may overemphasize treatment effects