Hankins Matthew
King's College London, Department of Psychology (at Guy's), Institute of Psychiatry, London, UK.
Health Qual Life Outcomes. 2008 May 27;6:36. doi: 10.1186/1477-7525-6-36.
The McMaster framework introduced by Kirshner & Guyatt is the dominant paradigm for the development of measures of health status and health-related quality of life (HRQL). The framework defines the functions of such instruments as evaluative, predictive or discriminative. Evaluative instruments are required to be sensitive to change (responsiveness), but there is no corresponding index of the degree to which discriminative instruments are sensitive to cross-sectional differences. This paper argues that indices of validity and reliability are not sufficient to demonstrate that a discriminative instrument performs its function of discriminating between individuals, and that the McMaster framework would be augmented by the addition of a separate index of discrimination. The coefficient proposed by Ferguson (Delta) is easily adapted to HRQL instruments and is a direct, non-parametric index of the degree to which an instrument distinguishes between individuals. While Delta should prove useful in the development and evaluation of discriminative instruments, further research is required to elucidate the relationship between the measurement properties of discrimination, reliability and responsiveness.
Kirshner和Guyatt提出的麦克马斯特框架是健康状况和健康相关生活质量（HRQL）测量方法发展的主导范式。该框架将此类工具的功能定义为评估、预测或区分。评估工具需要对变化敏感（反应性），但对于区分工具对横断面差异的敏感程度，没有相应的指标。本文认为，效度和信度指标不足以证明区分工具能够发挥其区分个体的功能，并且麦克马斯特框架应通过增加一个单独的区分指标来加以完善。Ferguson提出的系数（Delta）很容易应用于HRQL工具，并且是一个直接的非参数指标，用于衡量工具区分个体的程度。虽然Delta在区分工具的开发和评估中应会证明有用，但还需要进一步研究来阐明区分的测量属性、信度和反应性之间的关系。
