The Minimally Clinically Important Difference in Generic Utility-Based Measures
The Minimally Clinically Important Difference in Generic Utility-Based Measures
复制标题
基于通用实用性的措施中临床上最不重要的差异
作者：
R. Kaplan
目的：评估基于效用的一般生活质量测量的使用情况，以建立最小临床重要差异（MCID）。背景：基于效用的生活质量衡量标准将健康水平置于以死亡 (0.00) 和最佳功能 (1.00) 为基础的连续体上。偏好测量研究用于定义连续体上点的含义。相差小于 0.03 个单位的健康状况不能被评审团视为彼此不同。因此，0.03 是这些措施的合理 MCID。方法：三项已发表的慢性阻塞性肺疾病（COPD）患者研究报告了肺康复前后幸福质量量表（QWB）的数据。其中一项研究还随机分配患者接受肺减容手术或最大程度的药物治疗。这些患者平均随访 29 个月。结果：所有三项肺康复评估均显示 QWB 的变化超过了建议的 0.03 MCID。接受肺减容手术的患者的 QWB 变化在一年时接近 MCID 阈值，但在随后的几年中变得更强。使用 Norman 的 0.50 标准差方法，对康复效果和手术后一年结果的所有三个估计值均低于 MCID。结论：不同的MCID估计方法会导致关于肺康复和肺减容手术后生活质量变化的意义的不同结论。基于通用效用的生活质量测量中的偏好缩放系统提供了一个可直接解释的指标，并避免了对 MCID 测量的许多批评。该方法足够灵敏，可以表明康复和手术具有临床意义的益处。此外，质量调整生命年为政策分析提供了有价值的指标。基于效用的健康相关生活质量测量应该在慢性阻塞性肺病结果研究中得到更多的应用。
Purpose: To evaluate the use of utility-based generic quality of life measures for establishing the minimally clinically important difference (MCID). Background: Utility-based quality of life measures place levels of wellness on a continuum anchored by death (0.00) and optimum function (1.00). Preference measurement studies are used to define the meaning of points along the continuum. Health states that differ by less than 0.03 units cannot be discriminated by panels of judges as different from one another. Thus, 0.03 is a reasonable MCID for these measures. Method: Three published studies of patients with Chronic Obstructive Pulmonary Disease (COPD) reported data on the Quality of Well-being Scale (QWB) before and after pulmonary rehabilitation. One of the studies also randomly assigned patients to lung volume reduction surgery or to maximal medical therapy. These patients were followed for an average of 29 months. Results: All three evaluations of pulmonary rehabilitation showed changes on the QWB in excess of the proposed 0.03 MCID. QWB changes for patients assigned to lung volume reduction surgery were close to the MCID threshold at one year but grew stronger in subsequent years. Using Norman's 0.50 standard deviation method, all three estimates of rehabilitation effectiveness and the outcomes one year following surgery fall below the MCID. Conclusion: Different methods for estimating MCID lead to different conclusions about the meaning of quality of life changes following pulmonary rehabilitation and lung volume reduction surgery. The preference scaling system in generic utility-based quality of life measures provides a metric that is directly interpretable and avoids many of the criticisms of MCID measures. The method is sensitive enough to suggest clinically meaningful benefits of rehabilitation and surgery. Further, quality adjusted life years offer a valuable metric for policy analysis. Utility-based measures of health related quality of life should gain greater use in COPD outcomes research.
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因关节炎而损失的质量调整生命年：性别、种族和社会阶层的影响。
DOI：
10.1002/art.1790090609
发表时间：
1996
期刊：
Arthritis care and research : the official journal of the Arthritis Health Professions Association.
影响因子：
--
作者：
Kaplan,RM;Alcaraz,JE;Anderson,JP;Weisman,M
通讯作者：
Weisman,M
DOI：
10.1164/rccm.200204-318oc
发表时间：
2003-03-15
影响因子：
24.7
作者：
Ries, AL;Kaplan, RM;Prewitt, LM
通讯作者：
Prewitt, LM
影响因子：
8.9
作者：
Guyatt, GH;Osoba, D;Norman, GR
通讯作者：
Norman, GR
DOI：
10.1176/ps.48.2.224
发表时间：
1997
期刊：
Psychiatric services (Washington, D.C.)
影响因子：
--
作者：
Pyne,JM;Patterson,TL;Kaplan,RM;Gillin,JC;Koch,WL;Grant,I
通讯作者：
Grant,I
肺减容手术后死亡风险较高的患者。
DOI：
10.1056/nejmoa11798
发表时间：
2001
期刊：
The New England journal of medicine
影响因子：
--
作者：
NationalEmphysemaTreatmentTrialResearchGroup;Fishman,Alfred;Fessler,Henry;Martinez,Fernando;McKennaJr,RobertJ;Naunheim,Keith;Piantadosi,Steven;Weinmann,Gail;Wise,Robert
通讯作者：
Wise,Robert