Wyrwich Kathleen W, Spertus John A, Kroenke Kurt, Tierney William M, Babu Ajit N, Wolinsky Fredric D
Department of Research Methodology, Saint Louis University, St Louis, MO 63103, USA.
Am Heart J. 2004 Apr;147(4):615-22. doi: 10.1016/j.ahj.2003.10.039.
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.
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.
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.
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.
本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，该标准可通过慢性心力衰竭问卷（CHQ）的修订版以及医学结局研究简明健康调查问卷（SF - 36，第2版）识别个体随时间出现的微小、中度和较大变化。此前确定CHQ重要差异标准的工作主要集中在患者感知的变化上。尚未有针对心脏病患者的SF - 36重要差异标准发表。CID标准的制定将有助于在日常临床决策中使用健康状况测量指标。
我们采用了兰德适宜性方法的一种改良形式，组建并指导了一个由9名医生组成的共识小组，这些医生在心脏病患者中使用CHQ或SF - 36方面具有丰富经验。
基于他们自己使用这些测量指标的经验以及对描述这些工具的开发和使用的文章的广泛回顾，专家小组就CHQ和SF - 36得分的微小、中度和较大临床相关变化达成了共识。该小组确定的CID标准略高于先前使用患者感知变化为CHQ确定的最小重要差异标准。
该专家小组确定的CID标准为判断常规临床健康状况评估是否会使患者受益以及增强医生在临床环境中的决策能力提供了一个重要且有用的工具。
