Dowie Jack
Public Health and Policy Department, London School of Hygiene and Tropical Medicine, Kepper Street, London WC1E 7HT, UK.
Health Econ. 2002 Jan;11(1):1-8. doi: 10.1002/hec.667.
When a HRQOL measure is needed in health care decision making should it be a generic measure (a GEN), intended to cover the entire domain of health, a condition-specific measure (a CSM) intended to embrace those aspects of health associated with the condition concerned, or both? This paper proposes that it will never be appropriate to use both a CSM and a GEN for the same decision; that a GEN alone will probably be the appropriate measure in the majority of decisions; that a CSM alone will sometimes be appropriate; and that whether it is a GEN alone or a CSM alone that is appropriate depends entirely on the structure of the decision. The argument rests on the distinction between knowledge validity and decision validity. But it has a supplementary basis in rejection of the widespread (but unjustifiable) belief that CSMs are more "sensitive" or "responsive" than GENs and hence can detect "small but important changes" that GENs always or often miss.
在医疗保健决策中需要使用健康相关生活质量（HRQOL）测量方法时，应该使用通用测量方法（GEN），即旨在涵盖健康的整个领域，还是使用特定疾病测量方法（CSM），即旨在涵盖与相关疾病有关的健康方面，或者两者都用呢？本文提出，在同一决策中同时使用CSM和GEN永远都不合适；在大多数决策中，仅使用GEN可能是合适的测量方法；有时仅使用CSM是合适的；并且仅使用GEN还是仅使用CSM合适完全取决于决策的结构。该论点基于知识效度和决策效度之间的区别。但它还有一个补充依据，即反对普遍存在（但不合理）的观点，即CSM比GEN更“敏感”或“有反应性”，因此能够检测到GEN总是或经常遗漏的“微小但重要的变化”。
