Wong Man Yu, Yang Yingsi, Cao Zhiqiang, Guo Vivian Y W, Lam Cindy L K, Wong Carlos K H
Department of Mathematics, The Hong Kong University of Science and Technology, Kowloon, Hong Kong.
Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.
Eur J Cancer Care (Engl). 2018 Nov;27(6):e12926. doi: 10.1111/ecc.12926. Epub 2018 Oct 5.
This study was to assess the impact of HRQOL on health service utilisation using four different count data models. The HRQOL was measured using the Short-Form Six-Dimension instrument and the functional assessment of cancer therapy-colorectal whereas health service utilisation was measured by the number of monthly clinical consultations and the number of monthly hospitalisation. Different count data models (Poisson's regression, negative binomial regression, zero-inflated Poisson's regression and zero-inflated negative binomial regression) were used to assess the association between HRQOL and health service utilisation. A performance comparison was made between the models. Goodness-of-fit statistics (the Pearson's chi-squared test statistic, the Akaike and Bayesian information criteria) were used to determine the best-fitting model. The negative binomial model performed the best in assessing the association between HRQOL measures and health service utilisation in patients with colorectal neoplasm and thus recommended. Physical well-being of patients was negatively and significantly associated with the monthly rate of health service utilisation after controlling for patient demographics. Both physical and function well-beings of patients were negatively and significantly associated with the number of monthly hospitalisations. If the data for the condition-specific FACT-C are not available, SF-6D showed a very strong negative relationship with health service utilisation. Such models can be used to guide the allocation of clinical resources and funding for the care of colorectal cancer patients.
本研究旨在使用四种不同的计数数据模型评估健康相关生活质量（HRQOL）对医疗服务利用的影响。HRQOL采用简式六维量表和癌症治疗功能评估量表-结直肠癌模块进行测量，而医疗服务利用则通过每月临床会诊次数和每月住院次数来衡量。使用不同的计数数据模型（泊松回归、负二项回归、零膨胀泊松回归和零膨胀负二项回归）来评估HRQOL与医疗服务利用之间的关联。对这些模型进行了性能比较。采用拟合优度统计量（皮尔逊卡方检验统计量、赤池信息准则和贝叶斯信息准则）来确定最佳拟合模型。负二项模型在评估结直肠肿瘤患者HRQOL指标与医疗服务利用之间的关联方面表现最佳，因此被推荐使用。在控制患者人口统计学因素后，患者的身体健康与每月医疗服务利用率呈负相关且具有显著意义。患者的身体和功能健康均与每月住院次数呈负相关且具有显著意义。如果无法获得特定疾病的FACT-C数据，SF-6D与医疗服务利用呈现出非常强的负相关关系。此类模型可用于指导结直肠癌患者临床资源的分配和护理资金的投入。
