Patient-reported outcomes and the mandate of measurement
Patient-reported outcomes and the mandate of measurement
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DOI：
10.1007/s11136-008-9408-4
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发表时间：
2008-12-01
影响因子：
3.5
通讯作者：
Donaldson, Gary
中科院分区：
文献类型：
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作者：
Donaldson, Gary
连贯的临床护理取决于回答一个基本问题：病人是在恶化，好转，还是保持不变？这可以证明是令人惊讶的难以自信地回答。患者报告结局（PRO）可能通过提供可量化的证据而有所帮助。但可量化的证据并不一定是好证据，正如本文所详述的那样，衡量的基本任务要求评估中的误差小于要衡量的区别。这一要求意味着对患者的数值观察可能是不好的测量，个体评估需要高的测量精度和可靠性。组平均比较可以抵消测量误差，但单个PRO不能。可以肯定的是，单个专业人员会产生数字，但这些数字可能达不到我们应该要求的测量值。当测量的典型误差很大时，即使是病人病情恶化或好转这样一个温和的问题，也不可能有信心地回答。本文解释了测量任务背后的一些理论，提供了几个基于临床研究的例子，并提出了更精确地测量和监测个体病人预后的策略。这些措施包括更频繁地进行低负担评估，更现实的置信水平，以及加强纳入人口数据的衡量。
Coherent clinical care depends on answering a basic question: is a patient getting worse, getting better, or staying about the same? This can prove surprisingly difficult to answer confidently. Patient-reported outcomes (PROs) could potentially help by providing quantifiable evidence. But quantifiable evidence is not necessarily good evidence, as this article details.The fundamental mandate of measurement requires that errors in making an assessment be smaller than the distinctions to be measured. This mandate implies that numerical observations of patients may be poor measurements.Individual assessments require high measurement precision and reliability. Group-averaged comparisons cancel out measurement error, but individual PROs do not. Individual PROs generate numbers, to be sure, but the numbers may fall short of what we should demand of measurements. When typical errors of measurement are large, it is not possible to answer confidently even the modest question of whether a patient is getting worse or getting better.This article explains some theory behind the mandate of measurement, provides several examples based on clinical research, and suggests strategies to measure and monitor individual patient outcomes more precisely. These include more frequent low-burden assessments, more realistic confidence levels, and strengthened measurement that integrates population data.