BACKGROUND & AIMS: PURPOSE:The aim of this study was to assess the measurement properties of the 5-level classification system of the EQ-5D (5L), in comparison with the 3-level EQ-5D (3L). METHODS:Participants (n = 3,919) from six countries, including eight patient groups with chronic conditions (cardiovascular disease, respiratory disease, depression, diabetes, liver disease, personality disorders, arthritis, and stroke) and a student cohort, completed the 3L and 5L and, for most participants, also dimension-specific rating scales. The 3L and 5L were compared in terms of feasibility (missing values), redistribution properties, ceiling, discriminatory power, convergent validity, and known-groups validity. RESULTS:Missing values were on average 0.8% for 5L and 1.3% for 3L. In total, 2.9% of responses were inconsistent between 5L and 3L. Redistribution from 3L to 5L using EQ dimension-specific rating scales as reference was validated for all 35 3L-5L-level combinations. For 5L, 683 unique health states were observed versus 124 for 3L. The ceiling was reduced from 20.2% (3L) to 16.0% (5L). Absolute discriminatory power (Shannon index) improved considerably with 5L (mean 1.87 for 5L versus 1.24 for 3L), and relative discriminatory power (Shannon Evenness index) improved slightly (mean 0.81 for 5L versus 0.78 for 3L). Convergent validity with WHO-5 was demonstrated and improved slightly with 5L. Known-groups validity was confirmed for both 5L and 3L. CONCLUSIONS:The EQ-5D-5L appears to be a valid extension of the 3-level system which improves upon the measurement properties, reducing the ceiling while improving discriminatory power and establishing convergent and known-groups validity.

背景与目标： 目的：本研究的目的是评估EQ-5D（5L）的5级分类系统与3级EQ-5D（3L）的测量性能。
方法：来自六个国家的参与者（n = 3,919），包括八个患有慢性病（心血管疾病，呼吸系统疾病，抑郁症，糖尿病，肝病，人格障碍，关节炎和中风）的患者组和一个学生队列，完成了3L和5L，对于大多数参与者，还包括特定于维度的等级量表。比较了3L和5L的可行性（缺失值），重新分配属性，上限，区分能力，收敛效度和已知群体效度。
结果：5升漏失平均值平均为3升，漏失值为1.3％。总计2.9％的响应在5L和3L之间不一致。对于所有35种3L-5L级组合，均使用EQ尺寸特定等级量表作为参考，从3L重新分配到5L。对于5升，观察到683个独特的健康状态，而对于3升则观察到124个。上限从20.2％（3L）降低到16.0％（5L）。绝对判别力（Shannon指数）在5L时有显着提高（5L平均值为1.87，3L为1.24），相对判别力（Shannon均匀度指数）略有提高（5L分别为0.81和3L分别为0.78）。证实了与WHO-5的收敛效度，并与5L相比略有改善。 5L和3L均确认了已知组的有效性。
结论：EQ-5D-5L似乎是三级系统的有效扩展，它改善了测量性能，降低了上限，同时提高了鉴别能力，并建立了收敛性和已知群体的有效性。

BACKGROUND & AIMS: BACKGROUND:There is a paucity of published guidelines on managing dyspepsia in general practice. Existing guidelines emphasize the role of investigations and drugs rather than management approaches. Focus groups are a means of uncovering the way in which the participants think and work in the pragmatic-setting, and have not previously been formally used in creating guidelines.

AIM:To develop guidelines for the management of dyspepsia and to assess the use of focus groups of general practitioners (GPs) in order to do so.

METHOD:Initial evidence-based guidelines were proposed by a group of four GPs with an audit facilitator, and used for discussion in three focus groups using a standard format. An anthropological analysis of the proceedings led to modifications of the original guidelines, based on knowledge, perceptions and attitudes. The study was set in three distinct locations involving 30 GPs. The outcome measures consisted of feedback, categorized by types of responses, from the analysis of the focus groups and the creation of guidelines.

RESULTS:The resulting guidelines were patient centred and based on the principles of good consultation. They encompassed patients' fears and doctors' clinical uncertainties, and allowed flexibility in the individual patient's management. The focus group methodology exposed a substantial number of GPs to guideline development, and had the added benefits of dissemination, peer review and educational challenge.

CONCLUSION:It was possible to develop guidelines for dyspepsia using focus groups. The methodology had the added benefits of ownership, peer review, exposure of educational gaps and locality factors, and dissemination of good practice. It included steps from evidence review to implementation strategies. The development of this technique could lead to a strategy towards the creation and application of evidence-based and professionally acceptable clinical guidelines and practice on a locality basis nationally.

背景与目标： 背景：在一般情况下，有关消化不良的已发布指南很少。现有指南强调调查和药物的作用，而不是管理方法。焦点小组是揭示参与者在务实环境中思考和工作方式的一种方式，以前从未在制定指南中正式使用过。

AIM ：要发展

METHOD ：最初的循证指南是由一位专家提出的。一组由审核员协助的四个GP，并使用标准格式在三个焦点小组中进行讨论。对程序的人类学分析导致​​根据知识，看法和态度对原始准则进行了修改。该研究在三个不同的地点进行，涉及30个GP。结果测量包括根据反馈类型进行的反馈，对焦点小组的分析以及指南的创建。

结果：结果指南以患者为中心，基于良好协商的原则。它们涵盖了患者的恐惧和医生的临床不确定性，并允许在个体患者的管理中保持灵活性。焦点小组的方法使大量的GP可以接受指南的制定，并具有传播，同行评审和教育挑战的额外好处。

结论：可以为以下方面制定指南消化不良使用焦点小组。该方法具有所有权，同行评议，暴露教育差距和地区因素以及传播良好实践等附加好处。它包括从证据审查到实施策略的步骤。该技术的发展可能会导致制定在全国范围内基于证据的，专业认可的临床指南和实践的策略。