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Decision validity should determine whether a generic or condition-specific HRQOL measure is used in health care
1Public Health and Policy Department, London School of Hygiene and Tropical Medicine, Kepper Street, London WC1E 7HT, UK. jack.dowie@lshtm.ac.uk
Insights
For health care decisions, choose either a generic measure (GEN) or a condition-specific measure (CSM), but never both. The decision validity determines whether a GEN or CSM is appropriate, not their perceived sensitivity.
Area of Science:
- Health Services Research
- Outcomes Research
- Health Economics
Background:
- Health-related quality of life (HRQOL) measures are crucial for health care decision-making.
- Generic measures (GENs) assess overall health, while condition-specific measures (CSMs) focus on particular diseases.
Purpose of the Study:
- To propose guidelines for selecting appropriate HRQOL measures in health care decision-making.
- To clarify the appropriate use of generic versus condition-specific measures.
Main Methods:
- The study employs a theoretical framework based on the distinction between knowledge validity and decision validity.
- It critically evaluates the common assumption of CSMs' superior sensitivity over GENs.
Main Results:
- It is never appropriate to use both a CSM and a GEN for the same decision.
- A GEN alone is likely appropriate for most decisions.
- A CSM alone may be appropriate in certain situations, depending on decision structure.
Conclusions:
- The choice between a GEN or CSM depends on the specific decision's structure and validity requirements.
- The belief in CSMs' inherent greater sensitivity is challenged and deemed unjustifiable.
Abstract:
When a HRQOL measure is needed in health care decision making should it be a generic measure (a GEN), intended to cover the entire domain of health, a condition-specific measure (a CSM) intended to embrace those aspects of health associated with the condition concerned, or both? This paper proposes that it will never be appropriate to use both a CSM and a GEN for the same decision; that a GEN alone will probably be the appropriate measure in the majority of decisions; that a CSM alone will sometimes be appropriate; and that whether it is a GEN alone or a CSM alone that is appropriate depends entirely on the structure of the decision. The argument rests on the distinction between knowledge validity and decision validity. But it has a supplementary basis in rejection of the widespread (but unjustifiable) belief that CSMs are more "sensitive" or "responsive" than GENs and hence can detect "small but important changes" that GENs always or often miss.