使用核心讨论组方法研究肺结核病人生存质量的构成领域和方面

[目的]目前国内外尚未发现成熟的肺结核病人生存质量专用量表,本研究采用核心讨论组方法,探讨肺结核病人生存质量的构成领域和方面.[方法]深圳市龙岗区和宝安区41名肺结核病人、家属及医务人员按照不同类型分为6个核心讨论组,使用半结构化的形式开展核心讨论.讨论过程进行书面记录和录音,并采用定性分析方法对讨论结果进行分析.[结果]肺结核病人的生存质量主要由4个领域、8个方面构成,分剔为:生理机能(包含一般生理、疾病生理)、心理机能(包含消极心理、治疗心理、歧视感)、社会机能(包含治疗经济、社会支持与环境)及健康教育领域.[结论]肺结核病人生存质量的构成领域和方面除了普适性问题外,还包含了体现肺结核病人特异性的问题,诸如疾病的心理负担、被歧视感、治疗的经济负担及健康教育的需求等.核心讨论组方法有助于构建肺结核病人生存质量测定量表的领域和方面.     

中国结直肠癌患者生活质量研究系统评价

目的系统了解我国2006-2015年结直肠癌患者生活质量(quality of life,Qo L)研究现状,为后期研究提供方向参考。方法基于Pub Med、中国知网和万方开展系统文献检索,摘录基本情况(包括发表文献、研究对象、内容和方法等),概括涉及量表并汇总分析不同类型量表的评价结果。结果最终纳入76项研究,44项发表于近3年,涉及全国24个省份;以横断面(36项)或临床试验(33项)的设计最多,调查时机多为治疗结束后(60项)。文献共涉及11种量表,包括7种特异性量表[最常用的为生活质量核心调查问卷(QLQ-C30),共41项]和4种通用性量表[最常用的为健康相关生命质量量表(SF-36),共12项];几乎所有量表均有关注躯体、生理和社会关系维度,但具体维度内容和数量不同。所有Qo L量化指标均为量表或维度得分,未见健康效用值数据。以特异性量表QLQ-C30为例,采用不同国家模型映射所得结果差异明显,韩国和英国模型映射所得效用值中位数值分别为0.867和0.165。此外,SF-36量表8个维度间得分差值较小(仅为3.5~9.9分),提示特定通用性量表分维度敏感性可能欠佳。结论我国结直肠癌生活质量研究数量增长较快,但相关效用值数据仍匮乏。基于国外映射模型的分析及结果解释应谨慎,后期工作可优先选择已有我国人群健康效用值积分体系的量表进行评价。     

农民工子女生命质量与健康促进生活方式之关系

目的 了解农民工子女生命质量与健康促进生活方式状况。方法 采用生命质量量表和健康促进生活方式量表,对廊坊市677(男399,女288)名农民工子女生理维度、心理维度 、社会维度 、独立性维度、环境维度、综合维度以及营养行为、自我实现、压力处理、健康责任、身体运动、人际关系进行调查。结果 农民工子女生命质量和健康促进生活方式各维度在性别、年级、年龄和经济状况方面差异存在不同的统计学意义(P<0.01～0.05)。身体运动对生命质量的生理健康、心理状态、社会关系、独立能力和综合领域5影响具有统计学意义(P<0.01～0.05)。人际关系对生命质量的心理状态、社会关系、独立能力和综合领4个维度有显著性贡献(P<0.01~0.05)。健康责任对生命质量的显著性贡献主要表现在生理健康、独立能力和综合领域3个维度(P<0.01~0.05)。结论 针对农民工子女健康促进生活方式与生命质量关系的特点,制定针对性的健康促进策略,以提高生命质量水平。     

产褥期妇女健康综合测评及影响因素分析

目的应用生命质量评价方法综合测评产褥期妇女健康水平，并进一步探讨产褥期妇女健康水平在社会学、医学、家庭与心理学等方面的影响因素。方法利用WHO统一设计调查表中的45个健康测试条目，应用生命质量评价方法从生理、心理和社会功能3个维度综合测评了产褥期妇女的健康水平，应用多元逐步回归分析方法探讨了产褥期妇女健康水平的影响因素。结果产褥期妇女在生理、心理和社会功能3个维度的健康水平均低于一般育龄妇女．其中心理健康评分最低；同时发现有18个因素能够影响产褥期妇女3个维度的健康评分。结论重视产褥期妇女的生理、心理和社会健康状况；社会、家庭和产妇应共同参与产褥期保健。     

中国医院住院患者体验和满意监测量表的开发研究：量表的初步形成

目的开发适合中国医院应用的住院患者体验与满意监测量表。方法通过检索国内外的相关文献,收集国外成熟的满意度量表,结合国内现有的量表,通过专家组对条目进行筛选并修正。结果研制出的CHPESM量表包含可及入院、一般住院服务、治疗服务、意见管理、环境与后勤以及出院指导6个维度28个核心条目,均采用Likert 5级评分法。结论 CHPESM量表具有较好的内容效度。     

癌症特异性多属性效用量表FACT-8D研制与应用介绍

八维癌症特异性效用量表（FACT-8D） 的开发为癌症领域经济学评价研究,尤其是癌症患者的健康效用值测量 提供了新的工具选择。部分国家已经完成或正在进行FACT-8D健康效用积分体系的构建,但国内关于该量表的信息仍然有 限。文章对FACT-8D进行系统介绍,首先,简述FACT-8D的开发过程及健康状态分级系统;其次,以澳大利亚为例,介绍 FACT-8D健康效用积分体系的构建方法、流程和结果;再次,总结FACT-8D的测量属性;最后,对该量表的应用与发展进行 展望。总之,应尽早参考标准化方案构建基于中国人群的FACT-8D效用积分体系,进一步验证FACT-8D的测量属性,探索针 对不同癌症种类患者的“附加”维度。     

母婴健康素养量表编制及考评

目的 编制母婴健康素养量表用以测量孕妇母婴健康素养,并对该量表的信度、效度和可行性进行评价.方法 参考《母婴健康素养——母婴健康素养55条》和相关文献构建量表框架并建立条目库,经条目筛选形成测试版量表,对207名孕妇进行实测后,检验量表信度、效度和可行性.结果 初步建立了包含74个条目的条目库,经条目筛选,最终形成了包含55个条目的母婴健康素养量表,分属基本知识和理念、健康生活方式与行为和基本技能3个维度.总量表和3个维度的Cronbach'sα系数分别为0.890,0.824,0.689和0.536;量表重测相关系数为0.897,分半相关系数为0.802;各条目与其所在的维度/方面相关性均较高;因子分析提取了7个公因子,解释65.99%的方差变异;孕妇大多能在8-15分钟内完成问卷.结论 母婴健康素养量表具有良好的信度、效度和可行性,但对各文化层次人群的适用情况有待于进一步研究.     

SF系列量表演变及SF-6D多属性效用量表的介绍

多属性效用量表已成为主要的健康效用值测量工具。尽管六维健康调查简表(SF-6D)在国内的应用日益增多,但缺乏对SF系列量表如何演变为SF-6D多属性效用量表的相关介绍。为促进SF-6D量表在国内的进一步应用,首先简要梳理了SF系列量表的演变,包括SF-18、SF-20、SF-36、SF-12以及SF-8等量表;然后介绍了SF-6D量表的健康状态描述系统和效用积分体系评分;最后对SF-6D量表在国内外的应用进行了总结,并对应用前景进行了展望。这将为国内开展经济学评价研究,尤其是效用值测量和成本–效用分析提供基础支持。     

患病群体的健康综合评价及其影响因素探讨

健康是一个复杂、多维的生物学和社会学现象 ,具有质和量的双重性 ,它包括生理健康、心理状态和社会功能三个维度 ,每个维度又包含多个范畴的内容。长期以来 ,人们多用发病率、死亡率、期望寿命等传统指标从生命数量角度对人群健康水平进行衡量 ,但一个良好的健康综合测量指标应能综合生命数量和生命质量的双重信息并概括健康的多维度内容 ,在此背景下 ,先后出现了用减寿人年数、无残疾期望寿命、失能调整生命年等指标 ,来评价疾病对人群健康的影响。随着人群对健康需求的提高以及健康观和医学模式的转变 ,人们越来越倾向于对人群健康状况作…     

QWB多属性效用量表的应用介绍

多属性效用量表已成为主要的健康效用值测量工具。良好适应状态质量评估量表(Quality of Well-Being Scale,QWB)作为国际通用六大成人MAU量表之一,在国内应用较少。为促进QWB量表在国内的进一步应用,文章首先梳理了QWB量表的发展历程,然后介绍了QWB量表的健康状态描述系统和效用积分体系,并重点介绍了QWB量表在国内外的应用现状,最后对QWB量表的应用前景进行了总结与展望,这将为国内开展卫生经济学评价研究,尤其是效用值测量与成本–效用分析研究提供参考与借鉴。     

Development and initial validation of a new preference-based disease-specific health-related quality of life instrument for erectile function

Health-related quality of life instruments may be generic or specific. In general, only generic instruments use preference-based scoring. We report on a novel approach to combine in one instrument the strengths of the specific approach, greater disease relevance and responsiveness, with those of preference-based scoring, generalizability through utilities. OBJECTIVES: The primary objective was to develop a self-administered, preference-based instrument capable of measuring utilities in the disease-specific context of erectile dysfunction (ED). METHODS: Content derivation/validation began with a literature review. Eight attributes (domains) were selected to provide clinical experts structure for focus group discussion. Four levels describing a continuum of dysfunction-function were defined for each domain. Each domain, including functional levels, was reviewed and modified until consensus was achieved regarding content. This content was then integrated into a preference based scoring instrument using two visual analogue scales (VAS) with which patients rated three 'marker' health states (representing mild, moderate and severe ED), their self-state and a previously validated external marker state. The instrument was pilot tested, and implemented in a clinical trial. Initial validation analyses have been performed. RESULTS: A self-administered, preference-based, VAS instrument was developed for use in the ED population, and the instrument was feasible to complete, was reliable beyond the threshold of acceptability established a priori and demonstrated good validity. Evidence of these properties accumulates over time and this study begins that process with this instrument. Responsiveness is being assessed in the context of a clinical trial.     

Deriving a Preference-Based Measure for People With Duchenne Muscular Dystrophy From the DMD-QoL

ObjectivesThis study generates a preference-based measure for capturing the quality of life of people with Duchenne muscular dystrophy (DMD) from a new measure of quality of life, DMD-QoL.MethodsA health state classification system was derived from the DMD-QoL based on psychometric performance of items, factor analysis, and item response theory analysis. Preferences for health states described by the classification system were elicited using an online discrete choice experiment survey with life years as an additional attribute, from members of the UK general population (n = 1043). Discrete choice experiment data was modeled using a conditional fixed-effects logit model and utility estimates were directly anchored on the 1 to 0 full health-dead scale.ResultsThe health state classification system has 8 dimensions: mobility, difficulty using hands, difficulty breathing, pain, tiredness, worry, participation, and feeling good about yourself. The standard model had mostly statistically significant coefficients and reflected the instrument’s monotonic structure. However, 2 dimensions had inconsistent coefficients (where utility increased as health worsened) and a consistent model was estimated that merged adjacent inconsistent severity levels. The best state defined by the classification system has a value of 1 and the worst state has a value of −0.559.ConclusionThe modeled results enable DMD-QoL-8D utility values to be generated using DMD-QoL or DMD-QoL-8D data to generate QALYs for people with DMD. QALYs can then be used to inform economic models of the cost-effectiveness of interventions in DMD. Future research comparing the psychometric performance of DMD-QoL-8D to existing generic preference-based measures, including EQ-5D-5L, is recommended.     

Deriving a Preference-Based Measure for Myelofibrosis from the EORTC QLQ-C30 and the MF-SAF

BackgroundUtility values are required for economic evaluation using cost-utility analyses. Often, generic measures such as the EuroQol five-dimensional questionnaire are used, but this may not appropriately reflect the health-related quality of life of patients with cancer including myelofibrosis.ObjectiveTo derive a condition-specific preference-based measure for myelofibrosis using appropriate existing measures, the Myelofibrosis-Symptom Assessment Form and the European Organisation for Research and Treatment of Cancer Quality of Life 30 Questionnaire.MethodsData from the Controlled Myelofibrosis Study with Oral JAK Inhibitor Treatment trial (n = 309) were used to derive the health state classification system. Psychometric and factor analyses were used to determine the dimensions of the classification system. Psychometric and Rasch analyses were then used to select an item to represent each dimension. Item selection was validated with experts. A selection of health states was valued by members of the general population using time trade-off. Finally, health state values were modeled using regression analysis to produce utility values for every state.ResultsThe Myelofibrosis 8 dimensions has eight dimensions: physical functioning, emotional functioning, fatigue, itchiness, pain under ribs on the left side, abdominal discomfort, bone or muscle pain, and night sweats. Regression models were estimated using time trade-off data from 246 members of the general population valuing a total of 33 states. The best performing model was a random effects maximum likelihood model producing utility values ranging from 0.089 to 1.ConclusionsThe Myelofibrosis 8 dimensions is a condition-specific preference-based measure for myelofibrosis. This measure can be used to generate utility values for myelofibrosis for any data set containing the Myelofibrosis-Symptom Assessment Form and the European Organisation for Research and Treatment of Cancer Quality of Life 30 Questionnaire data.     

A Systematic Review of the Literature on the Development of Condition-Specific Preference-Based Measures of Health

Background

Health state utility values (HSUVs) are required to calculate quality-adjusted life-years (QALYs). They are frequently derived from generic preference-based measures of health. However, such generic measures may not capture health attributes of relevance to specific conditions. In such cases, a condition-specific preference-based measure (CSPBM) may be more appropriate.

Objective

This systematic review aimed to identify all published accounts of developing CSPBMs to describe and appraise the methods used.

Method

We undertook a systematic search (of Embase, MEDLINE, PsycINFO, Web of Science, the Cochrane Library, CINAHL, EconLit, ASSIA and the Health Management Information Consortium database) to identify published accounts of CSPBM development up to July 2015. Studies were reviewed to investigate the methods used to design classification systems, estimate HSUVs, and validate the measures.

Results

A total of 86 publications were identified, describing 51 CSPBMs. Around two-thirds of these were QALY measures; the remainder were designed for clinical decision making only. Classification systems for 33 CSPBMs were derived from existing instruments; 18 were developed de novo. HSUVs for 34 instruments were estimated using a ‘composite’ approach, involving statistical modelling; the remainder used a ‘decomposed’ approach based on multi-attribute utility theory. Half of the papers that described the estimation of HSUVs did not report validating their measures.

Conclusion

Various methods have been used at all stages of CSPBM development. The choice between developing a classification system de novo or from an existing instrument may depend on the availability of a suitable existing measure, while the choice between a decomposed or composite approach appears to be determined primarily by the purpose for which the instrument is designed. The validation of CSPBMs remains an area for further development.