Techniques For Developing Health Quality of Life Scales for Point of Service Use

Clinical and health policy research frequently involves health status measurement using generic or disease specific instruments. These instruments are generally developed to arrive at several scales, each measuring a distinct domain of health quality of life (HQOL). Clinical settings are starting to explore how to integrate patient perspectives of HQOL outcomes into patient care. However, the length of many HQOL instruments poses a challenge in terms of patient burden, as well as clinic flow time. The most popular paradigm for scale construction utilizes classical test theory methodology and can lead to excessive and redundant items in an effort to bolster reliability measurements such as Cronbach’s alpha above levels of accepted reliability. This paper presents techniques for utilizing item response theory to arrive at single item scales that are diagnostically informative and short enough to have clinical utility. A danger of such dramatic scale reduction is that validity might be compromised. This danger is addressed in terms of criterion related validity and sensitivity to clinical changes over a 36 months period. The reduction methods are illustrated using selected scales from the Arthritis Impact Measurement Scales 2 (AIMS2) with data obtained from the study Pharmaceutical Care Outcomes: The Patient Role (PCOPR).     

关节炎老年患者机体失能及三级预防

目的了解关节炎老年患者身体失能状况。方法采用健康自测量表（SRHMS）和抑郁量表（DSI）,对207例关节炎老年患者和89例健康老人对照比较。结果①病例组女性、受教育程度≤小学、体力劳动、自养费≤800元／月、无医保、年门诊≥4次和医药费千元以上者分别是对照组的2．1,1．99,2．46,2．91,1．88,2．23和2．26倍;②病例组疼痛、ADL和IADL限显高于对照（P〈0．05）,生活满意和充实感分别较对照组低16％和47％（P〈0．01）。③负性情绪、多病共患、鳏寡独居与机体失能密切相关。结论广泛社会支持下的自我管理是预防老年关节炎机体失能的有效措施。