Tamim Hani, McCusker Jane, Dendukuri Nandini
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
Med Care. 2002 Dec;40(12):1186-95. doi: 10.1097/00005650-200212000-00006.
The economic evaluation of health interventions for older people is complicated by the difficulty in obtaining self-reports of quality of life from persons with cognitive impairments, physical impairments, or both.
Using the EQ-5D (EuroQoL) measures, to assess: (1) agreement between subjects and proxies on subject's quality of life ratings at different points in time; (2) agreement between subjects and proxies on change of subject's quality of life ratings over time; and (3) subject and proxy characteristics related to agreement.
Prospective study of subjects visiting hospital emergency departments (ED). Data were collected at enrollment in the ED and at follow-up, 1 and 4 months after the ED visit.
The study comprised 231 pairs of cognitively intact patients aged 65 years or older and their primary caregivers.
Quality of life was measured using both components of the EQ-5D scale, the index score and the Visual Analogue Scale (VAS). Demographic characteristics and health status (physical and mental) were measured for both subjects and proxies. Subjects and proxies were interviewed either in English or French.
There was low to moderate agreement between subjects and proxies at different points in time (intraclass correlation coefficient [ICC] = 0.22 to 0.59), and between subject and proxy change scores over time (ICC = 0-0.50), on both the index score and the VAS. Better agreement between subjects and proxies was found at the 4 months follow-up, when the subject was less depressed, and when the proxy's native language was English.
Proxy EQ-5D responses, either for a specific point in time or for assessing change over time, may not be valid measures of self-reported quality of life among older medically-ill patients.
对老年人健康干预措施进行经济评估存在复杂性，原因在于难以从认知障碍、身体障碍或两者皆有的人群中获取生活质量的自我报告。
使用EQ-5D（欧洲五维度健康量表）评估：（1）不同时间点受试者与其代理人对受试者生活质量评分的一致性；（2）受试者与其代理人对受试者生活质量评分随时间变化的一致性；（3）与一致性相关的受试者和代理人特征。
对前往医院急诊科（ED）就诊的受试者进行前瞻性研究。在急诊科登记时以及急诊就诊后1个月和4个月的随访时收集数据。
该研究包括231对65岁及以上认知功能正常的患者及其主要照顾者。
使用EQ-5D量表的两个组成部分，即指数得分和视觉模拟量表（VAS）来测量生活质量。对受试者和代理人都测量了人口统计学特征和健康状况（身体和精神方面）。受试者和代理人用英语或法语接受访谈。
在不同时间点，受试者与其代理人在指数得分和VAS上的一致性较低至中等（组内相关系数[ICC]=0.22至0.59），并且在生活质量评分随时间的变化得分上（ICC=0-0.50）也是如此。在4个月随访时，当受试者抑郁程度较轻且代理人的母语为英语时，受试者与代理人之间的一致性更好。
代理人对EQ-5D的回答，无论是针对特定时间点还是评估随时间的变化，可能都不是老年病患者自我报告生活质量的有效测量方法。
