Classification and regression tree uncovered hierarchy of psychosocial determinants underlying quality-of-life response shift in HIV/AIDS

被引：71

作者：

Li, Yuelin ^{[1
]}

Rapkin, Bruce ^{[2
]}

机构：

[1] Mem Sloan Kettering Canc Ctr, Dept Psychiat & Behav Sci, New York, NY 10022 USA

[2] Yeshiva Univ, Albert Einstein Coll Med, Dept Epidemiol & Populat Hlth, Bronx, NY 10461 USA

来源：

JOURNAL OF CLINICAL EPIDEMIOLOGY | 2009年 / 62卷 / 11期

关键词：

Response shift; Health-related quality of life; Classification and regression trees; Segmentation strategies; Idiographic quality of life assessment; Rpart; STRATIFICATION; PEOPLE; RISK;

D O I：

10.1016/j.jclinepi.2009.03.021

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objectives: Rapkin and Schwartz define response shift as otherwise unexplained, discrepant change in health-related quality of life (HRQOL) that is associated with change in cognitive appraisal. In this article, we demonstrate how a recursive partitioning (rpart) regression tree analytic approach may be used to explore cognitive changes to gain additional insight into response-shift phenomena. Study Design and Setting: Data are from the "Choices in Care Study," an evaluation of HIV+ Medicaid recipients' experiences and outcomes in care (N = 394). Cognitive assessment was based on the QOL appraisal battery. HRQOL was measured by the SF-36 Health Survey, version 2 (SF-36v2). Results: We used rpart to examine 6-month change in SF-36v2 mental composite score as a function of changes in appraisal, after controlling for patient characteristics, health changes, and intervening events. Rpart identified nine distinct patterns of cognitive change, including three associated with negative discrepancies, four with positive discrepancies, and two with no discrepancies. Conclusion: Rpart classification provides a nuanced treatment of response shift. This methodology has implications for evaluating programs, guiding decisions, and targeting care. (C) 2009 Elsevier Inc. All rights reserved.

引用

页码：1138 / 1147

页数：10

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