HOME Initiative

Harmonising Outcome Measures for Eczema (HOME) is an international consensus group of patients, clinicians, methodologists and industry. It was founded at its first meeting in Munich in 2010. Eczema trials had used dozens of different scoring tools, which made results hard to compare or pool (Healio). HOME defines which outcomes every eczema trial should measure. At HOME II it agreed four core domains: clinical signs, patient-reported symptoms, quality of life and long-term control. At HOME III it defined a symptom as anything the patient notices.

HOME Initiative [defines] EASI HOME Initiative [defines] POEM HOME Initiative [relates] Evidence-Based Dermatology

The core instruments. HOME then chose one instrument per domain using systematic reviews of validity. Clinician-reported signs: EASI (2014), chosen over SCORAD after reviewing 16 tools. Patient-reported symptoms: POEM (2015), the best-validated of 18 tools. At HOME VII (2019, published 2021), quality of life was assigned to the IDQoL for infants, the CDLQI for children and the DLQI for adults, and long-term control to RECAP or ADCT, which were judged similar in quality. The peak-itch NRS-11 (past 24 hours) was recommended only for adults and older children (Thomas et al., BJD 2021). For trials in 1–4-year-olds the core set is therefore EASI, POEM completed by a parent, and IDQoL or CDLQI depending on age.

EASI [part-of] HOME Initiative POEM [part-of] HOME Initiative SCORAD [relates] HOME Initiative

Why it matters to parents. HOME instruments are designed for trials, but POEM has a caregiver-reported version with no lower age limit, so a parent can score a toddler’s eczema weekly at home and bring the trend to the GP (Nottingham CEBD). The core set also shows where evidence is weak. A 2023 systematic review of written eczema action plans found that neither of its two trials used any HOME-recommended instrument and called for them in future RCTs (Thandi et al., Skin Health Dis 2023). Trials that skip the core set are harder to compare across treatments in Treatment Outcomes Comparison.

HOME Initiative [supports] Treatment Outcomes Comparison Written Eczema Action Plan [relates] HOME Initiative

Connections

• EASI — core instrument for clinical signs, source: Schmitt 2014
• POEM — core instrument for patient-reported symptoms, source: HOME VII 2021
• SCORAD — validated but not chosen as core signs instrument, source: Schmitt 2014
• Written Eczema Action Plan — trials used no HOME instruments, source: Thandi 2023
• Treatment Outcomes Comparison — common outcome set allows comparison across trials, source: Healio; HOME VII 2021