Meyer K B, Espindle D M, DeGiacomo J M, Jenuleson C S, Kurtin P S, Davies A R
Department of Quality Assessment, New England Medical Center, Boston, MA 02111.
Am J Kidney Dis. 1994 Aug;24(2):267-79. doi: 10.1016/s0272-6386(12)80192-2.
We report 3 years of experience with quarterly assessments of the self-reported health of dialysis outpatients using the Short Form-36 (SF-36) Health Survey. The SF-36 measures eight different dimensions of health: physical function, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social function, role limitations due to emotional problems, and general mental health. On each dimensions, the respondent receives a score from 0 to 100. A higher score indicates better health. Program logistics and results are described, including reliability coefficients, standard deviations, and standard errors of measurement for the SF-36 in this patient population. The SF-36 was completed an average of 4.4 times by 112 patients over an average 14-month follow-up; 40 patients responded at least six times. On most dimensions, the dialysis patients' scores were lower and more variable than those of a sample of the general US population matched for age and sex. For example, mean initial physical function score (+/- SD) was 48.5 +/- 31.2 for the dialysis patients and 84.8 +/- 23.3 for the general population. The mean initial general health perception score of the dialysis patients was 43.7 +/- 23.9 with 71.9 +/- 20.3 for the general population. In contrast, general mental health scores were more comparable. The mean initial general mental health score was 69.6 +/- 17.5 for our patients and 75.5 +/- 18.0 for the general population. Reliability (Cronbach's alpha) ranged from 0.77 for general mental health to 0.93 for physical function. The 95% confidence intervals around individual scores were approximately 20 points, except for role-physical and role-emotional, which were both approximately 30 points. Two case reports compare information obtained from the SF-36 with the dialysis team's assessments of the patient, as recorded in the medical record. The two patients' comments on reviewing their SF-36 results are also summarized. Patient reactions to the health status assessment program are explored, and potential benefits and areas for further work are outlined. Serial measurement of the health status of dialysis patients allows the recognition of clear patterns in individual patient responses. These patterns sometimes suggest that the patient is either substantially more or less impaired than the dialysis team had thought. Changes in these patterns, both transient and protracted, frequently exceed 95% confidence intervals for patient-level scores. Longitudinal health status profiles of individual dialysis patients, accumulated by repeated self-assessment using the SF-36, enhance rather than merely restate the providers' intuitive judgments expressed in the medical record.
我们报告了一项为期3年的经验，即使用简短健康调查问卷36项（SF - 36）对透析门诊患者的自我报告健康状况进行季度评估。SF - 36测量健康的八个不同维度：身体功能、因身体问题导致的角色受限、身体疼痛、总体健康感知、活力、社会功能、因情绪问题导致的角色受限以及总体心理健康。在每个维度上，受访者会得到一个0到100的分数。分数越高表明健康状况越好。本文描述了该项目的实施流程和结果，包括该患者群体中SF - 36的信度系数、标准差和测量标准误差。在平均14个月的随访期间，112名患者平均完成了4.4次SF - 36评估；40名患者至少回复了6次。在大多数维度上，透析患者的分数低于年龄和性别匹配的美国普通人群样本，且变化更大。例如，透析患者的初始身体功能平均得分（±标准差）为48.5±31.2，而普通人群为84.8±23.3。透析患者的初始总体健康感知平均得分为43.7±23.9，普通人群为71.9±20.3。相比之下，总体心理健康得分更具可比性。我们患者的初始总体心理健康平均得分为69.6±17.5，普通人群为75.5±18.0。信度（克朗巴哈系数）范围从总体心理健康的0.77到身体功能的0.93。除了身体角色和情绪角色维度的95%置信区间约为30分之外，个体得分的95%置信区间约为20分。两个病例报告将从SF - 36获得的信息与病历中记录的透析团队对患者的评估进行了比较。还总结了这两名患者对查看其SF - 36结果的评论。探讨了患者对健康状况评估项目的反应，并概述了潜在益处和进一步工作的领域。对透析患者健康状况的连续测量能够识别个体患者反应中的清晰模式。这些模式有时表明患者的受损程度比透析团队原本认为的要高得多或低得多。这些模式的变化，无论是短暂的还是持久的，经常超出患者个体得分的95%置信区间。通过使用SF - 36进行重复自我评估积累的个体透析患者的纵向健康状况概况，强化了而不仅仅是重申了病历中医生的直观判断。
