治疗髋膝关节骨关节炎的决策质量工具：心理测量学评估。
Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation.
机构信息
General Medicine Division, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), Boston, MA, USA.
出版信息
BMC Musculoskelet Disord. 2011 Jul 5;12:149. doi: 10.1186/1471-2474-12-149.
BACKGROUND
A high quality decision requires that patients who meet clinical criteria for surgery are informed about the options (including non-surgical alternatives) and receive treatments that match their goals. The aim of this study was to evaluate the psychometric properties and clinical sensibility of a patient self report instrument, to measure the quality of decisions about total joint replacement for knee or hip osteoarthritis.
METHODS
The performance of the Hip/Knee Osteoarthritis Decision Quality Instrument (HK-DQI) was evaluated in two samples: (1) a cross-sectional mail survey with 489 patients and 77 providers (study 1); and (2) a randomized controlled trial of a patient decision aid with 138 osteoarthritis patients considering total joint replacement (study 2). The HK-DQI results in two scores. Knowledge items are summed to create a total knowledge score, and a set of goals and concerns are used in a logistic regression model to develop a concordance score. The concordance score measures the proportion of patients whose treatment matched their goals. Hypotheses related to acceptability, feasibility, reliability and validity of the knowledge and concordance scores were examined.
RESULTS
In study 1, the HK-DQI was completed by 382 patients (79%) and 45 providers (58%), and in study 2 by 127 patients (92%), with low rates of missing data. The DQI-knowledge score was reproducible (ICC = 0.81) and demonstrated discriminant validity (68% decision aid vs. 54% control, and 78% providers vs. 61% patients) and content validity. The concordance score demonstrated predictive validity, as patients whose treatments were concordant with their goals had more confidence and less regret with their decision compared to those who did not.
CONCLUSIONS
The HK-DQI is feasible and acceptable to patients. It can be used to assess whether patients with osteoarthritis are making informed decisions about surgery that are concordant with their goals.
背景
高质量的决策要求符合手术临床标准的患者了解各种选择（包括非手术替代方案），并接受符合其目标的治疗。本研究旨在评估一种患者自我报告工具的心理测量学特性和临床敏感性，以衡量膝关节或髋关节骨关节炎全关节置换术决策的质量。
方法
使用两种样本评估髋/膝关节骨关节炎决策质量量表（HK-DQI）的性能：（1）489 名患者和 77 名提供者的横断面邮件调查（研究 1）；（2）考虑全关节置换的 138 名骨关节炎患者的患者决策辅助工具的随机对照试验（研究 2）。HK-DQI 的结果有两个分数。知识项目加总形成总分，一组目标和关注点用于逻辑回归模型，以开发一致性得分。一致性得分衡量治疗与目标相匹配的患者比例。检验了知识和一致性得分的可接受性、可行性、可靠性和有效性的假设。
结果
在研究 1 中，382 名患者（79%）和 45 名提供者（58%）完成了 HK-DQI，在研究 2 中，127 名患者（92%）完成了 HK-DQI，数据缺失率较低。DQI 知识得分具有可重复性（ICC=0.81），并具有判别效度（68%决策辅助工具与 54%对照组，78%提供者与 61%患者）和内容效度。一致性得分具有预测效度，因为治疗与目标一致的患者对其决策的信心和后悔程度低于治疗与目标不一致的患者。
结论
HK-DQI 对患者来说是可行和可接受的。它可用于评估骨关节炎患者是否就手术做出了符合其目标的知情决策。
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