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Agreement About Identifying Patients Who Change Over Time: Cautionary Results in Cataract and Heart Failure Patients
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2012 Mar-Apr
Source: Med Decis Making. 32(2):273-286. -
Alternative Title:Med Decis Making
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Description:Background
Preference-based measures of health-related quality of life all use the same dead = 0.00 to perfect health = 1.00 scale, but there are substantial differences among measures.
Objective
The objective is to examine agreement in classifying patients as better, stable, or worse.
Design
The EQ-5D, Health Utilities Index Mark 2 and Mark 3, Quality of Well-Being – Self-Administered, Short-Form 36 (Short-Form 6D), and disease-targeted measures were administered prospectively in two clinical cohorts.
Setting
The study was conducted at academic medical centers: University of California, Los Angeles; University of California, San Diego; University of Wisconsin-Madison; and University of Southern California.
Patients
Patients undergoing cataract extraction surgery with lens replacement completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Patients newly refereed to congestive heart failure specialty clinics completed the Minnesota Living with Heart Failure Questionnaire (MLHF).
Measurements
In both cohorts subjects completed surveys at baseline, one and six months. The NEI-VFQ-25 and MLHF were used as gold standards to assign patients to categories of change. Agreement was assessed using kappa.
Results
376 cataract patients were recruited. Complete data for baseline and the one-month follow-up were available on all measures for 210 cases. Using criteria specified by Altman, agreement was poor for six of nine pairs of comparisons and fair for three pairs. 160 heart failure patients were recruited. Complete data for baseline and the six-month follow-up were available for 86 cases. Agreement was negligible for five pairs and fair for one.
Limitations
The study was conducted on selected patients at a few academic medical centers.
Conclusions
The results underscore the lack of interchangeability among different preference-based measures.
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Pubmed ID:22009666
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Pubmed Central ID:PMC3749910
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