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Updated: Jul 21, 2026
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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Capturar la visión del paciente del cambio como una medida de resultado clínico
D Fischer1, A L Stewart, D A Bloch
1Palo Alto Medical Clinic, CA, USA.
JAMA
|September 29, 1999
Resumen
Las evaluaciones seriadas y retrospectivas de los pacientes sobre el cambio en el estado de salud muestran un escaso acuerdo. Las medidas retrospectivas son más sensibles y se alinean mejor con la satisfacción del paciente, lo que sugiere su valor en ensayos clínicos.
Área de la Ciencia:
- Reumatología Reumatología.
- Salud Resultados de la investigación de la investigación
- Metodología de ensayos clínicos.
Sus antecedentes:
- La medición del cambio en el estado de salud del paciente es crucial para los ensayos clínicos y la práctica.
- Los ensayos clínicos a menudo utilizan mediciones de pacientes en serie, mientras que la práctica se basa en evaluaciones retrospectivas.
- La correlación entre estos dos métodos de medición no se entiende bien.
Objetivo del estudio:
- Para comparar las mediciones de pacientes en serie con evaluaciones retrospectivas de pacientes para cambios en el dolor y la discapacidad.
- Para evaluar la concordancia, sensibilidad y correlación con la satisfacción del paciente entre los dos métodos.
Principales métodos:
- Una encuesta longitudinal de 202 pacientes con artritis crónica sometidos a nuevas terapias.
- Los datos se recopilaron al inicio, a las 6 semanas y a los 4 meses utilizando medidas en serie (escala analógica visual para el dolor, cuestionario de evaluación de la salud para la discapacidad) y medidas retrospectivas (escala Likert de 7 puntos).
- El análisis incluyó concordancia (pruebas McNemar, t), sensibilidades y correlaciones con la satisfacción del paciente.
Principales resultados:
- Las medidas seriadas y retrospectivas mostraron una correlación pobre, especialmente con pequeños cambios en el estado de salud (r = 0,13-0,21).
- Las correlaciones mejoraron con mayor cambio (r=0.45-0.71), pero el acuerdo general fue bajo (29%).
- Las evaluaciones retrospectivas fueron más sensibles al cambio y se correlacionaron mejor con la satisfacción del paciente.
Conclusiones:
- Los métodos seriales y retrospectivos para medir el cambio en el estado de salud producen resultados no concordantes.
- Las evaluaciones retrospectivas de los pacientes pueden mejorar la exhaustividad de los datos de los ensayos clínicos.
- La incorporación de evaluaciones retrospectivas podría mejorar la alineación de los hallazgos de los ensayos clínicos con la práctica clínica.
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