使用患者报告结局测量信息系统（PROMIS）健康领域评估脊柱手术患者的健康效用。
Estimating Health Utility in Patients Presenting for Spine Surgery Using Patient-reported Outcomes Measurement Information System (PROMIS) Health Domains.
机构信息
Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
出版信息
Spine (Phila Pa 1976). 2019 Jul 1;44(13):908-914. doi: 10.1097/BRS.0000000000002977.
STUDY DESIGN
Prospective cohort study.
OBJECTIVE
To evaluate whether Patient-Reported Outcomes Measurement Information System (PROMIS) health domains can effectively estimate health utility index values for patients presenting for spine surgery.
SUMMARY OF BACKGROUND DATA
Stable estimates of health utility are required to determine cost-effectiveness of spine surgery. There are no established methods to estimate health utility using PROMIS.
METHODS
We enrolled 439 patients with spine disease (mean age, 54 ± 18 yrs) presenting for surgery and assessed their health using the Medical Outcomes Study Short Form-12, version 2 (SF-12v2) and PROMIS domains. Standard health utility values were estimated from the SF-12v2. Participants were randomly assigned to derivation or validation cohort. In the derivation cohort, health utility values were estimated as a function of PROMIS domains using regression models. Model fit statistics determined the most parsimonious health utility estimation equation (HEE). In the validation cohort, values were calculated using the HEE. Estimated health utility values were correlated with SF-12v2-derived health utility values.
RESULTS
Mean preoperative health utility was 0.492 ± 0.008 and was similar between the two cohorts. All PROMIS health domains were significantly associated with health utility except Anxiety (P = 0.830) and Sleep Disturbance (P = 0.818). The final HEE was:Health Utility (est) = 0.70742 - 0.00471 × Pain + 0.00647 × Physical function - 0.00316 × Fatigue - 0.00214 × Depression + 0.00317 × Satisfaction with Participation in Social Roles.The estimation model accounted for 74% of observed variation in health utility. In the validation sample, mean health utility was 0.5033 ± 0.1684 and estimated health utility was 0.4966 ± 0.1342 (P = 0.401). These measures were strongly correlated (rho = 0.834).
CONCLUSION
Our results indicate that PROMIS provides a reasonable estimate of health utility in adults presenting for lumbar or cervical spine surgery.
LEVEL OF EVIDENCE
研究设计
前瞻性队列研究。
目的
评估患者报告的结果测量信息系统（PROMIS）健康领域是否可以有效地估计接受脊柱手术的患者的健康效用指数值。
背景数据概要
需要稳定的健康效用估计值来确定脊柱手术的成本效益。目前尚无使用 PROMIS 估计健康效用的既定方法。
方法
我们招募了 439 名患有脊柱疾病的患者（平均年龄 54±18 岁）接受手术，并使用医疗结局研究简表 12 项，第 2 版（SF-12v2）和 PROMIS 领域评估他们的健康状况。从 SF-12v2 中估计出标准健康效用值。参与者被随机分配到推导或验证队列。在推导队列中，使用回归模型将健康效用值表示为 PROMIS 领域的函数。模型拟合统计数据确定了最简约的健康效用估计方程（HEE）。在验证队列中，使用 HEE 计算值。估计的健康效用值与 SF-12v2 得出的健康效用值相关。
结果
术前平均健康效用为 0.492±0.008，两个队列之间相似。除焦虑（P=0.830）和睡眠障碍（P=0.818）外，所有 PROMIS 健康领域均与健康效用显著相关。最终的 HEE 为：健康效用（估计值）=0.70742-0.00471×疼痛+0.00647×身体功能-0.00316×疲劳-0.00214×抑郁+0.00317×对参与社会角色的满意度。该估计模型解释了健康效用观察到的变化的 74%。在验证样本中，平均健康效用为 0.5033±0.1684，估计的健康效用为 0.4966±0.1342（P=0.401）。这些措施具有很强的相关性（rho=0.834）。
结论
我们的结果表明，PROMIS 为接受腰椎或颈椎手术的成年人提供了健康效用的合理估计。
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