Epstein A M, Hall J A, Tognetti J, Son L H, Conant L
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115.
Med Care. 1989 Mar;27(3 Suppl):S91-8.
Instruments using interview data to measure health status have been increasingly used to measure patient outcomes. To assess the potential utility of proxy responses about health status when subjects are unable to respond, the authors compared the responses of 60 subject and proxy pairs on instruments measuring overall current health, functional status, social activity, emotional health, and satisfaction with medical care. Proxies were asked to respond as they thought the subject would. Subject and proxy responses were strongly correlated with each other for overall health, functional status, social activity, and emotional health (P less than .001), and moderately correlated for satisfaction (P less than .005). Proxies reported lower emotional health and satisfaction than did subjects (P less than .005). Proxy and subject mean responses were generally similar for overall health, functional status, and social activity. However, those proxies who spent more time per week helping the subject rated the subject's functional status and social activity as more impaired than did the subject (P less than .05). Subjects who had poorer overall health tended to rate their health relatively lower than did the proxies (P less than .05). These results suggest that use of proxies intermingled with subjects to measure health status through interview may lead to biased results.
利用访谈数据来衡量健康状况的工具越来越多地被用于衡量患者的治疗效果。为了评估在受试者无法做出回应时，代理报告的健康状况信息的潜在效用，作者比较了60对受试者与代理在衡量总体当前健康状况、功能状态、社交活动、情绪健康以及对医疗护理满意度的工具上的回答。要求代理按照他们认为受试者会做出的回答来作答。受试者与代理在总体健康、功能状态、社交活动和情绪健康方面的回答彼此高度相关（P值小于0.001），在满意度方面呈中度相关（P值小于0.005）。代理报告的情绪健康和满意度低于受试者（P值小于0.005）。在总体健康、功能状态和社交活动方面，代理与受试者的平均回答总体相似。然而，那些每周花费更多时间帮助受试者的代理，对受试者功能状态和社交活动的评价比受试者本人更高，认为其功能状态和社交活动受损更严重（P值小于0.05）。总体健康状况较差的受试者倾向于对自己健康状况的评价相对低于代理（P值小于0.05）。这些结果表明，通过访谈将代理与受试者混合使用来衡量健康状况可能会导致有偏差的结果。
