【摘要】：背景年齡相關(guān)性黃斑變性(AMD)是一種慢性、大部分難以治愈的眼底疾病,分為干性及濕性AMD兩種類(lèi)型。濕性AMD一般進(jìn)展迅速,會(huì)導(dǎo)致嚴(yán)重視力損傷,從而嚴(yán)重影響患者生活質(zhì)量,并帶來(lái)巨大經(jīng)濟(jì)負(fù)擔(dān)。使用標(biāo)準(zhǔn)化視覺(jué)相關(guān)生活質(zhì)量量表評(píng)估患者視功能成為逐漸普及的方式。國(guó)際上應(yīng)用于AMD患者的生活質(zhì)量問(wèn)卷較多,某一特定問(wèn)卷的推廣應(yīng)用需經(jīng)過(guò)嚴(yán)格的語(yǔ)言、文化及心理測(cè)量學(xué)的驗(yàn)證。中國(guó)大陸尚沒(méi)有經(jīng)過(guò)驗(yàn)證的特異性針對(duì)AMD患者的生活質(zhì)量問(wèn)卷。AMD患者因需要長(zhǎng)期治療、治療藥物昂貴,從而產(chǎn)生沉重經(jīng)濟(jì)負(fù)擔(dān)。國(guó)際上關(guān)于AMD患者經(jīng)濟(jì)負(fù)擔(dān)、醫(yī)療資源利用情況的研究較多,然而中國(guó)大陸尚沒(méi)有AMD患者經(jīng)濟(jì)負(fù)擔(dān)的定量數(shù)據(jù)。目的對(duì)視功能指數(shù)量表VF-14中文版本在中國(guó)大陸AMD患者人群中進(jìn)行修訂及信度效度驗(yàn)證。獲得中國(guó)大陸AMD患者經(jīng)濟(jì)負(fù)擔(dān)定量數(shù)據(jù)。方法1.嚴(yán)格按照心理測(cè)量學(xué)原則,對(duì)視功能指數(shù)量表VF-14中文版本在中國(guó)大陸AMD患者人群中進(jìn)行修訂及信度效度驗(yàn)證。2.通過(guò)橫斷面調(diào)查的方式,對(duì)患者進(jìn)行面對(duì)面問(wèn)卷訪問(wèn),得到AMD患者部分直接醫(yī)療花費(fèi)及全部直接非醫(yī)療花費(fèi)定量數(shù)據(jù)。通過(guò)回顧性隊(duì)列研究的方式,查閱北京協(xié)和醫(yī)院電子病歷系統(tǒng),得到AMD患者部分直接醫(yī)療花費(fèi)定量數(shù)據(jù)。3.使用Kruskal-Wallis秩和檢驗(yàn)分析方法,分析AMD患者經(jīng)濟(jì)負(fù)擔(dān)與視力水平之問(wèn)的相關(guān)性。結(jié)果137位AMD患者完成了VF-14中文版問(wèn)卷調(diào)查及經(jīng)濟(jì)負(fù)擔(dān)調(diào)查。根據(jù)統(tǒng)計(jì)分析及臨床專(zhuān)家建議,修改VF-14問(wèn)卷并去掉Q9、Q13及Q14,得到修訂版VF-11R。VF-11R具有較高的內(nèi)部信度,Cronbach's a為0.930；較高的重測(cè)信度,Cronbach's a為0.945,組內(nèi)相關(guān)系數(shù)為0.933；較高的分半信度,兩部分的Cronbach's a分別為0.840、0.895。所有信度檢驗(yàn)p0.01。VF-11R具有較高的結(jié)構(gòu)效度,因子分析提取了2個(gè)主成分因子,對(duì)總方差的累積解釋72.555%；較高的效標(biāo)效度,三個(gè)全面視覺(jué)自我評(píng)估問(wèn)卷中,題目“視力下降帶來(lái)的麻煩”,與VF-11R問(wèn)卷得分是普通負(fù)相關(guān)性,題目“對(duì)視力滿(mǎn)意度”與VF-11R問(wèn)卷得分是普通正相關(guān)性,題目“視力總體質(zhì)量”與VF-11R問(wèn)卷得分是顯著正相關(guān)性。所有效度檢驗(yàn)p0.01。每個(gè)患者年均直接醫(yī)療花費(fèi)為(44556.37±99208.04)元。其中,年均藥費(fèi)、檢查費(fèi)、治療費(fèi)及掛號(hào)費(fèi)分別占89.47%、5.22%、4.00%及1.31%。每個(gè)患者年均直接非醫(yī)療花費(fèi)為(456.78±10210.73)元。其中,年均路費(fèi)、食宿費(fèi)分別占72.45%、27.55%。每個(gè)患者年均總體就醫(yī)花費(fèi)為(49013.15±102082.97)元。患者因診治AMD產(chǎn)生的費(fèi)用,已超出其個(gè)人收入,AMD患者平均年花費(fèi)與年收入的比值為1.33±2.57。不同小數(shù)視力組(雙眼0.5,一眼0.5、一眼≤0.5,雙眼≤0.5)患者之間的直接醫(yī)療花費(fèi)、直接非醫(yī)療花費(fèi)、總體花費(fèi)均無(wú)統(tǒng)計(jì)學(xué)顯著性差異。不同加權(quán)平均視力(weight average logMAR, WMAR; WMAR=0.75×logMAR較佳視力眼視力+0.25×logMAR較差視力眼視力)(0-0.31、-0.32--0.55、-0.56--0.99及-1.00--1.80)患者之間的直接醫(yī)療花費(fèi)、直接非醫(yī)療花費(fèi)、總體花費(fèi)均無(wú)統(tǒng)計(jì)學(xué)顯著性差異。結(jié)論1.首次在中國(guó)大陸年齡相關(guān)性黃斑變性(AMD)患者人群中對(duì)VF-14中文版進(jìn)行了修正版的研制,得到VF-11R。VF-11R在中國(guó)大陸AMD患者中具有較高的信度和效度；2.首次獲得中國(guó)大陸AMD患者經(jīng)濟(jì)負(fù)擔(dān)數(shù)據(jù)。中國(guó)AMD患者因疾病治療產(chǎn)生沉重經(jīng)濟(jì)負(fù)擔(dān),尤以藥費(fèi)為著。
[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，

本文編號(hào)：2375206