University of Alberta Hospital, Edmonton, Alberta, Canada.
Qual Life Res. 2010 Apr;19(3):371-9. doi: 10.1007/s11136-010-9599-3. Epub 2010 Feb 10.
This randomized controlled clinical trial examined the usefulness of including an assessment of health-related quality of life (HRQL) in the routine clinical care of lung-transplant patients. We hypothesized that the inclusion of HRQL in routine clinical care would improve patient-clinician communication, affect clinical management, and improve patients' HRQL.
At the outpatient clinic, University of Alberta Hospital, patients were randomly assigned to intervention (completion of Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) on touch-screen computer with feedback to clinicians) and control group (completion of HUI2 and HUI3 on touch-screen computer without feedback). Feedback involved a graphical representation included in patients' chart. All clinical encounters were audio-taped. Changes in clinical management (medication changes, number of referrals and test ordered) were summed to produce an overall management composite. At the end of every visit, patients completed the EQ-5D.
Two hundred and thirteen patients were randomized (108 to intervention and 105 to control groups). There were statistically significant differences between the groups in mean number of issues discussed per encounter (P = 0.003; Cohen's d = 0.03) and mean management composite score (P = 0.001; Cohen's d = 0.41). EQ-5D index was not statistically significant different between the groups (P = 0.48).
We detected very small effects on patient-clinician communication and small effects on patient management, without detecting improvement in patient outcome.
本随机对照临床试验旨在检验在肺移植患者的常规临床护理中纳入健康相关生活质量（HRQL）评估的有效性。我们假设将 HRQL 纳入常规临床护理将改善医患沟通、影响临床管理并改善患者的 HRQL。
在阿尔伯塔大学医院的门诊，患者被随机分配至干预组（在触摸屏计算机上完成健康效用指数第 2 版（HUI2）和第 3 版（HUI3），并将反馈提供给临床医生）和对照组（在触摸屏计算机上完成 HUI2 和 HUI3，无反馈）。反馈涉及图表中包含的图形表示。所有临床接触都进行了录音。将临床管理的变化（药物变化、转诊和检查数量）进行汇总，以产生总体管理综合评分。在每次就诊结束时，患者完成 EQ-5D 量表。
共有 213 名患者被随机分配（干预组 108 名，对照组 105 名）。两组在每次就诊讨论的问题数量平均值（P=0.003；Cohen's d=0.03）和管理综合评分平均值（P=0.001；Cohen's d=0.41）方面存在统计学显著差异。EQ-5D 指数在两组之间无统计学显著差异（P=0.48）。
我们检测到医患沟通方面有很小的改善，以及患者管理方面有较小的改善，但没有检测到患者结局的改善。
