Ren Xinhua S, Selim Alfredo J, Fincke B Graeme, Linzer Mark, Kazis Lewis E
Center for Health Quality, Outcomes, and Economic Research, CHQOER, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA.
J Ambul Care Manage. 2006 Oct-Dec;29(4):320-31. doi: 10.1097/00004479-200610000-00008.
Prior research has consistently shown that among patients with chronic lung disease (CLD), health-related quality of life (HRQOL) is tied more to respiratory symptoms than to physiologic measures. However, traditional methods to quantify the severity of CLD have been restricted to physiologic measures (eg, FEV1, FVC, etc) that are often poor predictors of HRQOL and utilization of health services. Using a patient-based measure of symptom severity for CLD developed in the Veterans Health Study (VHS), this article evaluated the impact of the severity of CLD on patients' self-reported HRQOL and future use of health services. We used data from the VHS, a prospective study of patients receiving ambulatory care services in 4 Veterans Affairs outpatient clinics in the greater Boston area. Three hundred fifty-two (14.5%) patients were identified as having CLD through self-report of having a physician's diagnosis of chronic bronchitis, emphysema, or asthma, and either using inhaled medications or having a productive cough for most days for 3 months. Ordinary least-square regressions were used to ascertain the effects of CLD severity on functional health and health services use. Compared with peak expiratory flow rate, which explained only 10% and 2%, respectively, of the variance in the SF-36 physical component summary (PCS) and in future doctor visits, the symptom severity explained 19% and 19%, respectively, of the variance in PCS and future doctor visits, after adjusting for age, education, and household income. The symptom severity measure is a strong predictor of future functional health (at 12 months of the VHS baseline) and health services use (within 6 months following the baseline). The study findings indicate that our measure of CLD severity is an efficient and easy-to-use approach that can be readily administered in ambulatory setting. It can be used as a case-mix adjustment in evaluating health outcomes and in predicting future utilization of health services.
先前的研究一直表明，在慢性肺病（CLD）患者中，与健康相关的生活质量（HRQOL）更多地与呼吸道症状相关，而非生理指标。然而，传统的量化CLD严重程度的方法一直局限于生理指标（如第一秒用力呼气容积、用力肺活量等），而这些指标往往不能很好地预测HRQOL和医疗服务的利用情况。本文利用退伍军人健康研究（VHS）中开发的基于患者的CLD症状严重程度测量方法，评估了CLD严重程度对患者自我报告的HRQOL以及未来医疗服务使用的影响。我们使用了VHS的数据，这是一项对大波士顿地区4家退伍军人事务门诊接受门诊护理服务的患者进行的前瞻性研究。通过自我报告有医生诊断为慢性支气管炎、肺气肿或哮喘，并且使用吸入药物或在3个月内大多数日子有咳痰，352名（14.5%）患者被确定患有CLD。采用普通最小二乘法回归来确定CLD严重程度对功能健康和医疗服务使用的影响。与分别仅解释SF-36身体成分汇总（PCS）方差的10%和未来就诊方差的2%的呼气峰值流速相比，在调整年龄、教育程度和家庭收入后，症状严重程度分别解释了PCS方差和未来就诊方差的19%。症状严重程度测量是未来功能健康（在VHS基线12个月时）和医疗服务使用（在基线后6个月内）的有力预测指标。研究结果表明，我们的CLD严重程度测量方法是一种高效且易于使用的方法，可在门诊环境中轻松实施。它可作为病例组合调整指标，用于评估健康结果和预测未来医疗服务的利用情况。
