MONITORING DIALYSIS PATIENTS HEALTH-STATUS
MONITORING DIALYSIS PATIENTS HEALTH-STATUS
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DOI：
10.1016/s0272-6386(12)80192-2
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发表时间：
1994-08-01
影响因子：
13.2
通讯作者：
DAVIES, AR
中科院分区：
文献类型：
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作者：
MEYER, KB;ESPINDLE, DM;DAVIES, AR
我们报告3年的经验，每季度评估自我报告的健康透析门诊患者使用短表格36 （SF-36）健康调查。SF-36测量了八个不同的健康维度：身体功能、由于身体问题引起的角色限制、身体疼痛、一般健康感知、活力、社会功能、由于情绪问题引起的角色限制和一般心理健康。在每个维度上，被调查者得到从0到100的分数。分数越高表示健康状况越好。项目后勤和结果的描述，包括可靠性系数，标准偏差和标准误差测量的SF-36在该患者群体。在平均14个月的随访中，112名患者平均完成了4.4次SF-36；40名患者至少有6次反应。在大多数方面，与年龄和性别匹配的美国普通人口样本相比，透析患者的得分更低，变化更大。例如，透析患者的平均初始身体功能评分（±SD）为48.5±31.2，一般人群为84.8±23.3。透析患者的平均初始一般健康感知评分为43.7±23.9，而普通人群的平均初始一般健康感知评分为71.9±20.3。相比之下，一般心理健康得分更具可比性。患者的平均初始一般心理健康评分为69.6±17.5，一般人群的平均初始一般心理健康评分为75.5±18.0。信度（Cronbach’s α）从一般心理健康的0.77到身体机能的0.93不等。个体得分的95%置信区间约为20分，除了角色-身体和角色-情感，两者都约为30分。两份病例报告比较了从SF-36中获得的信息与透析小组对患者的评估，这些评估记录在医疗记录中。本文还总结了两位患者对SF-36检查结果的评价。探讨了患者对健康状况评估计划的反应，并概述了潜在的益处和进一步工作的领域。对透析患者的健康状况进行连续测量，可以识别出个体患者反应的清晰模式。这些模式有时表明病人的损害程度比透析小组所认为的要严重或严重。这些模式的变化，无论是短暂的还是长期的，经常超过患者水平评分的95%置信区间。个体透析患者的纵向健康状况概况，通过使用SF-36的反复自我评估积累，增强而不仅仅是重申医疗记录中表达的提供者的直觉判断。
We report 3 years of experience with quarterly assessments of the self-reported health of dialysis outpatients using the Short Form-36 (SF-36) Health Survey. The SF-36 measures eight different dimensions of health: physical function, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social function, role limitations due to emotional problems, and general mental health. On each dimension, the respondent receives a score from 0 to 100. A higher score indicates better health. Program logistics and results are described, including reliability coefficients, standard deviations, and standard errors of measurement for the SF-36 in this patient population. The SF-36 was completed an average of 4.4 times by 112 patients over an average 14-month follow-up; 40 patients responded at least six times. On most dimensions, the dialysis patients' scores were lower and more variable than those of a sample of the general US population matched for age and sex. For example, mean initial physical function score (±SD) was 48.5 ± 31.2 for the dialysis patients and 84.8 ± 23.3 for the general population. The mean initial general health perception score of the dialysis patients was 43.7 ± 23.9 compared with 71.9 ± 20.3 for the general population. In contrast, general mental health scores were more comparable. The mean initial general mental health score was 69.6 ± 17.5 for our patients and 75.5 ± 18.0 for the general population. Reliability (Cronbach's α) ranged from 0.77 for general mental health to 0.93 for physical function. The 95% confidence intervals around individual scores were approximately 20 points, except for role-physical and role-emotional, which were both approximately 30 points. Two case reports compare information obtained from the SF-36 with the dialysis team's assessments of the patient, as recorded in the medical record. The two patients' comments on reviewing their SF-36 results are also summarized. Patient reactions to the health status assessment program are explored, and potential benefits and areas for further work are outlined. Serial measurement of the health status of dialysis patients allows the recognition of clear patterns in individual patient responses. These patterns sometimes suggest that the patient is either substantially more or less impaired than the dialysis team had thought. Changes in these patterns, both transient and protracted, frequently exceed 95% confidence intervals for patient-level scores. Longitudinal health status profiles of individual dialysis patients, accumulated by repeated self-assessment using the SF-36, enhance rather than merely restate the providers' intuitive judgments expressed in the medical record.