Miller Donald R, Clark Jack A, Rogers William H, Skinner Katherine M, Spiro Avron, Lee Austin, Kazis Lewis E
Center for Health Quality, Outcomes, and Economics Research (CHQOER), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA.
J Ambul Care Manage. 2005 Apr-Jun;28(2):111-24. doi: 10.1097/00004479-200504000-00003.
Patient-based assessments of functional status and well-being, such as the short form survey (SF-36) developed in the Medical Outcomes Study, are increasingly used to monitor patient health status and the effects of medical care. Although they have been used in many populations under a variety of circumstances, little is known about how environmental factors, such as place of administration, influence patients' responses. We administered the SF-36 as part of comprehensive quality-of-life assessments to 304 participants in the pilot phase of the Veterans Health Study, a large observational study of health outcomes in VA ambulatory care. SF-36 questionnaires were self-administered twice by patients, once at home and again as part of an interview in a clinic setting. For most participants, less than a week passed between the 2 administrations. Scores from these questionnaires were compared as a measure of reliability and of the possible influence of place of administration. Questionnaires self-administered at the time of the interview yielded mean scores that were significantly (P<.05) higher across all 8 SF-36 scales (physical function, role function with physical and emotional limitations, vitality, bodily pain, social function, mental health, general health perceptions) and both the physical and mental component summary scales. With scores scaled from 0 to 100, differences ranged from 2.1 (bodily pain) to 5.7 (role limitations due to emotional problems). Mean physical function was 56.8 at the time of the interview, and 52.4 at home. Higher scores from questionnaires administered at interview outnumbered lower scores by 3 to 2 for most scales. These differences remained even after restricting the sample to those with the highest cognitive function scores and the shortest interval between administrations. Because selection factors and order of administration could not be completely dismissed, a large number of other administrative, clinical, and sociodemographic factors were examined, which, however, failed to provide adequate explanation for these differences. Careful consideration should be given concerning the physical and social environment in the administration of health-related quality-of-life assessments. Findings from this study suggest that more favorable measures of self-reported functional status and well-being may be expected from clinic administrations of instruments.
基于患者的功能状态和幸福感评估，如医学结局研究中开发的简短问卷调查（SF - 36），越来越多地用于监测患者健康状况和医疗护理效果。尽管它们已在各种情况下被应用于许多人群，但对于诸如施测地点等环境因素如何影响患者的回答却知之甚少。在退伍军人健康研究的试点阶段，我们将SF - 36作为综合生活质量评估的一部分，施测于304名参与者，该研究是一项关于退伍军人事务部门诊医疗健康结局的大型观察性研究。SF - 36问卷由患者自行填写两次，一次在家中，另一次作为在诊所环境中访谈的一部分。对于大多数参与者，两次施测之间间隔不到一周。对这些问卷的得分进行比较，以衡量可靠性以及施测地点可能产生的影响。在访谈时自行填写的问卷在所有8个SF - 36量表（身体功能、有身体和情感限制的角色功能、活力、身体疼痛、社会功能、心理健康、总体健康感知）以及身体和心理综合量表上的平均得分均显著更高（P <.05）。得分范围为0至100，差异在2.1（身体疼痛）至5.7（因情感问题导致的角色限制）之间。访谈时的平均身体功能得分为56.8，在家中为52.4。在大多数量表上，访谈时填写问卷获得的较高得分与较低得分的比例为3比2。即使将样本限制为认知功能得分最高且两次施测间隔最短的人群，这些差异仍然存在。由于无法完全排除选择因素和施测顺序的影响，我们还研究了大量其他管理、临床和社会人口学因素，但这些因素未能对这些差异提供充分解释。在进行与健康相关的生活质量评估时，应仔细考虑身体和社会环境。这项研究的结果表明，在诊所环境中使用这些工具进行自我报告的功能状态和幸福感评估可能会得到更有利的结果。
