Wyrwich Kathleen W, Metz Stacie M, Kroenke Kurt, Tierney William M, Babu Ajit N, Wolinsky Fredric D
Department of Research Methodology, Saint Louis University, St. Louis, MO, USA.
Health Serv Res. 2007 Dec;42(6 Pt 1):2257-74; discussion 2294-323. doi: 10.1111/j.1475-6773.2007.00733.x.
To use triangulation methodology to better understand clinically important differences (CIDs) in the health-related quality of life (HRQoL) of patients with heart disease.
DATA SOURCES/STUDY SETTING: We used three information sources: a nine-member expert panel, 656 primary care outpatients with coronary artery disease (CAD) and/or congestive heart failure (CHF), and the 46 primary care physicians (PCPs) treating these outpatients. From them, we derived CIDs for the Modified Chronic Heart Failure Questionnaire (CHQ) and the Medical Outcomes Study Short Form 36-Item Health Status Survey, Version 2 (SF-36).
The expert physician panel employed Delphi and consensus methods to obtain CIDs. The outpatients received bimonthly HRQoL interviews for 1 year that included the CHQ and SF-36, as well as retrospective assessments of HRQoL changes. Their PCPs assessed changes in the patient's condition at follow-up clinic visits that were linked to HRQoL assessments to determine change over time.
DATA COLLECTION/EXTRACTION METHODS: Patient- and PCP-assessed changes were categorized as trivial (no change), small, moderate, or large improvements or declines. Moderate or large changes in HRQoL reflect the added risk or investment associated with some treatment modifications. Estimates for each categorization were calculated by finding the mean change scores within anchored change classifications.
The small CID for the CHQ domains was consistently one to two points using the patient-assessed change categorizations, but small CIDs varied greatly for the SF-36. PCP-assessed changes differed substantially from patient estimates for both the CHQ and SF-36, while the panel-derived estimates were generally larger than those derived from patients.
Triangulation methodology provides a framework for securing a deeper understanding of each informant group's perspective on CIDs for these patient-reported outcome measures. These results demonstrate little consensus and suggest that the derived estimates depend on the rater and assessment methodology.
运用三角测量法，以更好地理解心脏病患者健康相关生活质量（HRQoL）中具有临床重要意义的差异（CIDs）。
数据来源/研究背景：我们使用了三个信息来源：一个由九名专家组成的小组、656名患有冠状动脉疾病（CAD）和/或充血性心力衰竭（CHF）的初级保健门诊患者，以及治疗这些门诊患者的46名初级保健医生（PCP）。从中，我们得出了改良慢性心力衰竭问卷（CHQ）和医学结果研究简明健康状况调查问卷第2版（SF-36）的CIDs。
专家医生小组采用德尔菲法和共识法来获取CIDs。门诊患者在1年中每两个月接受一次HRQoL访谈，访谈内容包括CHQ和SF-36，以及对HRQoL变化的回顾性评估。他们的初级保健医生在随访门诊时评估患者病情的变化，并将其与HRQoL评估相关联，以确定随时间的变化情况。
数据收集/提取方法：患者和初级保健医生评估的变化分为微不足道（无变化）、小、中或大的改善或下降。HRQoL的中度或大的变化反映了与某些治疗调整相关的额外风险或投入。通过在固定的变化分类中找到平均变化分数来计算每个分类的估计值。
使用患者评估的变化分类时，CHQ领域的小CIDs始终为1至2分，但SF-36的小CIDs差异很大。对于CHQ和SF-36，初级保健医生评估的变化与患者估计值有很大差异，而小组得出的估计值通常大于患者得出的估计值。
三角测量法提供了一个框架，有助于更深入地理解每个信息提供者群体对这些患者报告结局指标中CIDs的看法。这些结果显示几乎没有共识，并表明得出的估计值取决于评估者和评估方法。
