健康相關生活品質之效用測量方法信度與效度的評估：以血液透析之末期腎病患者為例

Reliability and Validity of Utility Approach to Measuring Health Related Quality of Life: An Example of Patients on Hemodialysis

林榮第(Rong-Dih Lin) ； 游芝亭(Chin-Tin Yu) ； 姚開屏(Kai-Ping Grace Yao) ； 王榮德(Jung-Der Wang)

《中華公共衛生雜誌》 16卷5期 (1997/10) Pp. 404-416

https://doi.org/10.6288/CJPH1997-16-05-03

摘要

健康相關生活品質的測量已逐漸被運用於臨床決策、決定衛生政策優先順序、評估衛生計畫效益及經濟學之成本－效用分析上。本研究首先嘗試以血液透析患者為研究對象，對時間交換及評價等級兩種效用測量方法在健康相關生活品質之測量上的信度及效度進行評估，希望能建立起一個適合我國國情的健康狀態效用評估方法，並逐步修改而推廣到其他健康狀態的效用評估上，以作為臨床決策、衛生政策分析及計畫評估的參考指標。本研究採橫斷研究法，以1993年8月至11月期間，在臺北市三所教學醫院之血液透析中心接受長期血液透析，能夠並願意接受訪問的所有末期腎病息者為研究對象。由標準化訪視員以結構式問卷進行訪視及再測。共有125名患者完成訪問，回應率為90%。研究結果發現，時間交換及評價等級兩種效用測量方法對於不同的訪視者、不同的訪視時間及不同的訪視方法或訪現情境，都可得到穩定的結果，而且兩種方法在建構效度及效標相關效度等效度檢定上，均具有良好的表現。標準賭博、時間交換及評價等級等方法所測得的血液透析患者之健康相關生活品質的效用數值分別為0.75、0.61與0.57。
在健康狀態效用的測量方法中，標準賭博、時間交換及評價等級皆具有良好的信度及效度。但說可行性而言，時間交換及評價等級是較受大多數學者所建議採行的方法。另外，由終評價等級施測貿易且所得結果與其他方法同樣具有信度及效度，故很適合應用於大規模的研究。

關鍵字

健康相關生活品質 ； 效用 ； 信度 ； 效度

並列摘要

The measure of health-related quality of life has been used progressively in clinical decision making, public health priority setting, assessing the effectiveness of health programs and economic cost-utility analysis. The purpose of this study is to evaluate the reliability and validity of two utility measurement techniques including time tradeoff and rating scale in the measure of health-related quality of life in order that we could develop an indicator for health policy decision and program evaluation based on Chinese cultural background. Subjects of this cross-sectional study consisted of all the patients of end-stage renal disease receiving maintenance hemodialysis at the hemodialysis room of three teaching hospitals in the Taipei between August 1993 and November 1993. Interviews were undertaken by standardized interviewers with a structured questionnaire. 125 subjects completed the interview. The response rate was about 90%. The results showed that both time tradeoff and rating scale measurement techniques got consistent results by different interviewers and method and at different interviewing time and situations. These two measurement techniques had good performance in the assessment of validity including construct validity and criterion-related validity. The utility values measured by standard gamble, time tradeoff, and rating scale were 0.75, 0.61, and 0.57 respectively.
Standard gamble, time tradeoff and rating scale are all reliable and valid techniques in the measure of health-related quality of life. Based on feasibility, the time tradeoff and rating scale methods are more popular with most investigators. The rating scale method is easiest to administer and appears to yield results that are as valid as any other method. Thus, this would seem to be the method of choice in large-sample studies.

並列關鍵字

healthy-related quality of life ； utility ； reliability ； validity