中国年龄相关性黄斑变性人群视功能指数量表验证及经济负担分析
发布时间：2018-12-12 20:32
【摘要】：背景年龄相关性黄斑变性(AMD)是一种慢性、大部分难以治愈的眼底疾病,分为干性及湿性AMD两种类型。湿性AMD一般进展迅速,会导致严重视力损伤,从而严重影响患者生活质量,并带来巨大经济负担。使用标准化视觉相关生活质量量表评估患者视功能成为逐渐普及的方式。国际上应用于AMD患者的生活质量问卷较多,某一特定问卷的推广应用需经过严格的语言、文化及心理测量学的验证。中国大陆尚没有经过验证的特异性针对AMD患者的生活质量问卷。AMD患者因需要长期治疗、治疗药物昂贵,从而产生沉重经济负担。国际上关于AMD患者经济负担、医疗资源利用情况的研究较多,然而中国大陆尚没有AMD患者经济负担的定量数据。目的对视功能指数量表VF-14中文版本在中国大陆AMD患者人群中进行修订及信度效度验证。获得中国大陆AMD患者经济负担定量数据。方法1.严格按照心理测量学原则,对视功能指数量表VF-14中文版本在中国大陆AMD患者人群中进行修订及信度效度验证。2.通过横断面调查的方式,对患者进行面对面问卷访问,得到AMD患者部分直接医疗花费及全部直接非医疗花费定量数据。通过回顾性队列研究的方式,查阅北京协和医院电子病历系统,得到AMD患者部分直接医疗花费定量数据。3.使用Kruskal-Wallis秩和检验分析方法,分析AMD患者经济负担与视力水平之问的相关性。结果137位AMD患者完成了VF-14中文版问卷调查及经济负担调查。根据统计分析及临床专家建议,修改VF-14问卷并去掉Q9、Q13及Q14,得到修订版VF-11R。VF-11R具有较高的内部信度,Cronbach's a为0.930；较高的重测信度,Cronbach's a为0.945,组内相关系数为0.933；较高的分半信度,两部分的Cronbach's a分别为0.840、0.895。所有信度检验p0.01。VF-11R具有较高的结构效度,因子分析提取了2个主成分因子,对总方差的累积解释72.555%；较高的效标效度,三个全面视觉自我评估问卷中,题目“视力下降带来的麻烦”,与VF-11R问卷得分是普通负相关性,题目“对视力满意度”与VF-11R问卷得分是普通正相关性,题目“视力总体质量”与VF-11R问卷得分是显著正相关性。所有效度检验p0.01。每个患者年均直接医疗花费为(44556.37±99208.04)元。其中,年均药费、检查费、治疗费及挂号费分别占89.47%、5.22%、4.00%及1.31%。每个患者年均直接非医疗花费为(456.78±10210.73)元。其中,年均路费、食宿费分别占72.45%、27.55%。每个患者年均总体就医花费为(49013.15±102082.97)元。患者因诊治AMD产生的费用,已超出其个人收入,AMD患者平均年花费与年收入的比值为1.33±2.57。不同小数视力组(双眼0.5,一眼0.5、一眼≤0.5,双眼≤0.5)患者之间的直接医疗花费、直接非医疗花费、总体花费均无统计学显著性差异。不同加权平均视力(weight average logMAR, WMAR; WMAR=0.75×logMAR较佳视力眼视力+0.25×logMAR较差视力眼视力)(0-0.31、-0.32--0.55、-0.56--0.99及-1.00--1.80)患者之间的直接医疗花费、直接非医疗花费、总体花费均无统计学显著性差异。结论1.首次在中国大陆年龄相关性黄斑变性(AMD)患者人群中对VF-14中文版进行了修正版的研制,得到VF-11R。VF-11R在中国大陆AMD患者中具有较高的信度和效度；2.首次获得中国大陆AMD患者经济负担数据。中国AMD患者因疾病治疗产生沉重经济负担,尤以药费为著。
[Abstract]:Background Age-related macular degeneration (AMD) is a chronic, most difficult-to-cure fundus disease, divided into two types of dry and wet AMD. The rapid progress of wet AMD can lead to severe visual impairment, which seriously affects the quality of life of the patient and has a great economic burden. The standardized vision-related quality of life scale was used to assess the patient's visual function as a way of becoming more popular. The quality of life questionnaire applied to AMD patients is much higher in the world. The application of a particular questionnaire needs to be verified by strict language, culture and psychometrics. The mainland of China does not have a validated quality of life questionnaire for AMD patients. AMD patients are expensive to treat due to the need for long-term treatment, resulting in a heavy economic burden. There are more studies on the economic burden of AMD patients and the utilization of medical resources. However, there is no quantitative data on the economic burden of AMD patients in China. Objective To verify the revision and reliability of the visual function finger number table VF-14 Chinese version in the Chinese mainland AMD patients. To obtain the quantitative data on the economic burden of AMD patients in mainland China. Method 1. In strict accordance with the psychometric principle, the revision and the reliability-effect verification of the visual function finger number table VF-14 Chinese version in the Chinese mainland AMD patient population are carried out. Through a cross-sectional survey, a face-to-face questionnaire was conducted to the patient to obtain part of the direct medical expense and all of the direct non-medical expense quantitative data for AMD patients. Through a retrospective cohort study, the electronic medical record system of Peking Union and Hospital was reviewed to obtain the quantitative data for partial direct medical treatment of AMD patients. The relationship between the economic burden of AMD and the level of vision was analyzed by using the Kruskal-Wallis rank and the test method. Results The VF-14 Chinese version of the questionnaire and the economic burden investigation were completed in 137 patients with AMD. According to the statistical analysis and the clinical expert's suggestion, the VF-14 questionnaire was revised and Q9, Q13 and Q14 were removed to obtain the revised VF-11R.VF-11R with a high internal reliability. The Cronbach's a of the two parts were 0.840, and 0.895, respectively. All the reliability test p0.01. VF-11R had a higher structural efficiency, the factor analysis extracted two principal component factors, the cumulative explanation of the total variance was 72.555%, the higher effect degree, the three comprehensive visual self-assessment questionnaire, the subject 鈥淎 problem with a drop in vision.鈥，
本文编号：2375206
[Abstract]:Background Age-related macular degeneration (AMD) is a chronic, most difficult-to-cure fundus disease, divided into two types of dry and wet AMD. The rapid progress of wet AMD can lead to severe visual impairment, which seriously affects the quality of life of the patient and has a great economic burden. The standardized vision-related quality of life scale was used to assess the patient's visual function as a way of becoming more popular. The quality of life questionnaire applied to AMD patients is much higher in the world. The application of a particular questionnaire needs to be verified by strict language, culture and psychometrics. The mainland of China does not have a validated quality of life questionnaire for AMD patients. AMD patients are expensive to treat due to the need for long-term treatment, resulting in a heavy economic burden. There are more studies on the economic burden of AMD patients and the utilization of medical resources. However, there is no quantitative data on the economic burden of AMD patients in China. Objective To verify the revision and reliability of the visual function finger number table VF-14 Chinese version in the Chinese mainland AMD patients. To obtain the quantitative data on the economic burden of AMD patients in mainland China. Method 1. In strict accordance with the psychometric principle, the revision and the reliability-effect verification of the visual function finger number table VF-14 Chinese version in the Chinese mainland AMD patient population are carried out. Through a cross-sectional survey, a face-to-face questionnaire was conducted to the patient to obtain part of the direct medical expense and all of the direct non-medical expense quantitative data for AMD patients. Through a retrospective cohort study, the electronic medical record system of Peking Union and Hospital was reviewed to obtain the quantitative data for partial direct medical treatment of AMD patients. The relationship between the economic burden of AMD and the level of vision was analyzed by using the Kruskal-Wallis rank and the test method. Results The VF-14 Chinese version of the questionnaire and the economic burden investigation were completed in 137 patients with AMD. According to the statistical analysis and the clinical expert's suggestion, the VF-14 questionnaire was revised and Q9, Q13 and Q14 were removed to obtain the revised VF-11R.VF-11R with a high internal reliability. The Cronbach's a of the two parts were 0.840, and 0.895, respectively. All the reliability test p0.01. VF-11R had a higher structural efficiency, the factor analysis extracted two principal component factors, the cumulative explanation of the total variance was 72.555%, the higher effect degree, the three comprehensive visual self-assessment questionnaire, the subject 鈥淎 problem with a drop in vision.鈥，
本文编号：2375206
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