Clinically important differences in health status for patients with heart disease: An expert consensus panel report
Clinically important differences in health status for patients with heart disease: An expert consensus panel report
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DOI：
10.1016/j.ahj.2003.10.039
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发表时间：
2004-04-01
影响因子：
4.8
通讯作者：
Wolinsky, FD
中科院分区：
文献类型：
--
作者：
Wyrwich, KW;Spertus, JA;Wolinsky, FD
背景：该研究的目的是为冠心病和充血性心力衰竭患者制定临床重要差异(CID)标准，以确定慢性心力衰竭问卷(CHQ)和简式36项健康调查(SF-36，Version 2)中随时间变化的个体内小、中、大变化。在确定CHQ的重要差异标准方面，先前的工作主要集中在患者感知的变化上。对于心脏病患者，SF-36还没有公布重要的区别标准。CIDs的这一发展将有助于在日常临床决策中使用健康状况衡量标准。方法我们使用改进的RAND适宜性方法来组建和指导一个由9名医生组成的共识小组，这些医生在心脏病患者中具有丰富的CHQ或SF-36使用经验。结果根据他们自己使用这些措施的经验和对描述这些工具的开发和使用的文章的广泛审查，专家小组就CHQ和SF-36的小、中、大临床相关分数变化达成了共识。结论本专家组建立的CID标准为临床健康状况评估是否有利于患者、提高医生在临床环境中的决策能力提供了一个重要的有用工具。
Background The purpose of the study was to develop clinically important difference (CID) standards for patients with coronary artery disease and congestive heart failure that identify small, moderate, and large intraindividual changes with time in a modified version of the Chronic Heart Failure Questionnaire (CHQ) and the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36, version 2). Prior work in ascertaining important difference standards for the CHQ have centered on patient-perceived changes. No important difference standards for the SF-36 have been published for patients with heart disease. This development of CIDs would facilitate the use of health status measures in daily clinical decision-making.Methods We used a modification of the RAND Appropriateness Method to assemble and guide a 9-member consensus panel of physicians with substantial experience in using the CHQ or the SF-36 among patients with heart disease.Results On the basis of their own experience using these measures and an extensive review of articles describing the development and use of these instruments, the expert panel achieved consensus on small, medium, and large clinically relevant changes in scores for the CHQ and SF-36. The CID standards established by this panel were slightly higher than the minimal important difference standards previously established for the CHQ using patient-perceived changes.Conclusions The CID standards established by this expert panel provide an important and useful tool for determining whether routine clinical health status assessments will benefit patients and enhance physicians' decision-making capacity in clinical settings.