Sullivan L M, Dukes K A, Harris L, Dittus R S, Greenfield S, Kaplan S H
Primary Care Outcomes Research Institute of New England Medical Center, Boston, MA 02111, USA.
Med Care. 1995 Apr;33(4 Suppl):AS183-94.
In a randomized trial of different data collection methods, we challenged the untested assumption that reliable data cannot be obtained from lower-income and/or minority patients by self-administered questionnaires. We tested three methods of data collection among a sample of lower-income and minority patients (n = 697) in Indianapolis at a site for the Type II Diabetes Patient Outcomes Research Team. The study included a questionnaire literacy screening instrument to assess patients' functional literacy. Based on their functional literacy, patients were randomized to one of three methods of data collection: mail-out/mail-back, hand-out/assisted, or the in-home interview. We constructed a tiered system for reassigning nonresponders to alternative methods of data collection, using the in-home interview as the fall-back strategy. We compared the response rates, item completion rates, and internal consistency reliabilities of self-reported health status measures between patients with and without literacy limitations and across the three methods of data collection. Patients with and without literacy limitations, across methods of data collection, provided high-quality data, as evidenced by high item completion rates (> 84%) and high reliability assessments (internal consistency reliability coefficients > .80) for each health status measure. As part of the tiered study design, nonresponders randomized to either the mail-out/mail-back or the hand-out/assisted method were interviewed. These patients were significantly older, had significantly lower education and income levels, and had significantly poorer self-reported visual function as compared with those who responded to the originally assigned method. We conclude that expensive, labor-intensive data collection methods, such as in-home interviews, are not necessary for many low-income, minority patients to generate high-quality, reliable health status data. Using appropriate screening instruments, those patient subgroups needing special help can be screening instruments, those patient subgroups needing special help can be identified and targeted for more expensive data collection methods. This tiered approach has policy implications for the cost, feasibility, and quality of data collection in health outcomes research.
在一项关于不同数据收集方法的随机试验中，我们对一个未经检验的假设提出了质疑，即通过自行填写问卷无法从低收入和/或少数族裔患者那里获得可靠数据。我们在印第安纳波利斯市一个II型糖尿病患者结局研究团队的站点，对697名低收入和少数族裔患者样本进行了三种数据收集方法的测试。该研究包括一份问卷读写能力筛查工具，以评估患者的功能读写能力。根据其功能读写能力，患者被随机分配到三种数据收集方法之一：邮寄/回寄、发放/协助填写或上门访谈。我们构建了一个分层系统，将无应答者重新分配到其他数据收集方法，以上门访谈作为备用策略。我们比较了有读写能力限制和无读写能力限制的患者之间，以及三种数据收集方法下自我报告健康状况测量的应答率、项目完成率和内部一致性信度。无论有无读写能力限制，在各种数据收集方法下，患者都提供了高质量的数据，每项健康状况测量的高项目完成率（>84%）和高信度评估（内部一致性信度系数>.80）证明了这一点。作为分层研究设计的一部分，对随机分配到邮寄/回寄或发放/协助填写方法但无应答的患者进行了访谈。与对最初分配方法作出应答的患者相比，这些患者年龄显著更大，教育和收入水平显著更低，自我报告的视觉功能也显著更差。我们得出结论，对于许多低收入少数族裔患者而言，诸如上门访谈等昂贵且劳动密集型的数据收集方法并非产生高质量、可靠健康状况数据所必需。使用适当的筛查工具，可以识别需要特殊帮助的患者亚组，并针对他们采用更昂贵的数据收集方法。这种分层方法对健康结局研究中数据收集的成本、可行性和质量具有政策意义。
