Benson Tim, Bowman Clive
R-Outcomes Ltd, Thatcham, Berkshire, UK
Institute of Health Informatics, UCL, London, UK.
BMJ Open Qual. 2020 Mar;9(1). doi: 10.1136/bmjoq-2019-000801.
Many care home residents cannot self-report their own health status. Previous studies have shown differences between staff and resident ratings. In 2012, we collected 10 168 pairs of health status ratings using the health status measure. This paper examines differences between staff and resident ratings.
is a short generic person-reported outcome measure with four items: pain or discomfort (discomfort), feeling low or worried (distress), limited in what you can do (disability) and require help from others (dependence). A summary score ( score) is also calculated. Mean scores are shown on a 0-100 scale. High scores are better than low scores. Differences between resident and staff reports (bias) were analysed at the item and summary level by comparing distributions, analysing correlations and a modification of the Bland-Altman method.
Distributions are similar superficially but differ statistically. Spearman correlations are between 0.55 and 0.67. For items, more than 92.9% of paired responses are within one class; for the summary score, 66% are within one class. Mean differences (resident score minus staff score) on 0-100 scale are pain and discomfort (-1.11), distress (0.67), discomfort (1.56), dependence (3.92) and summary score (1.26). The variation is not the same for different severities. At higher levels of pain and discomfort, staff rated their discomfort and distress as better than residents. On the other hand, staff rated disability and dependence as worse than did residents. This probably reflects differences in perspectives. Red amber green (RAG) thresholds of 10 and 5 points are suggested for monitoring changes in care home mean scores.
许多养老院居民无法自行报告自身健康状况。先前的研究表明，工作人员与居民的评分存在差异。2012年，我们使用健康状况测量方法收集了10168对健康状况评分。本文研究工作人员与居民评分之间的差异。
是一种简短的通用个人报告结局测量方法，包含四个项目：疼痛或不适（不适）、情绪低落或担忧（苦恼）、活动受限（残疾）以及需要他人帮助（依赖）。还计算了一个汇总分数（分数）。平均分数以0至100分的量表呈现。高分优于低分。通过比较分布、分析相关性以及对布兰德 - 奥特曼方法的修改，在项目和汇总层面分析居民与工作人员报告之间的差异（偏差）。
分布表面上相似，但在统计学上存在差异。斯皮尔曼相关性在0.55至0.67之间。对于各个项目，超过92.9%的配对回答处于同一类别；对于汇总分数，66%处于同一类别。在0至100分的量表上，平均差异（居民分数减去工作人员分数）分别为：疼痛和不适（-1.11）、苦恼（0.67）、不适（1.56）、依赖（3.92）以及汇总分数（1.26）。不同严重程度的差异不尽相同。在疼痛和不适程度较高时，工作人员对居民不适和苦恼的评分高于居民自身。另一方面，工作人员对残疾和依赖的评分低于居民。这可能反映了观点上的差异。建议使用10分和5分的红黄绿（RAG）阈值来监测养老院平均分数的变化。
