Congruence of Patient Self-Rating of Health with Family Physician Ratings

Abstract

Background: A single self-rated health (SRH) question is associated with health outcomes, but agreement between SRH and physician-rated patient health (PRPH) has been poorly studied. We studied patient and physician reasoning for health ratings and the role played by patient lifestyle and objective health measures in the congruence between SRH and PRPH.Methods: Surveys of established family medicine patients and their physicians, and medical record review at 4 offices. Patients and physicians rated patient health on a 5-point scale and gave reasons for the rating and suggestions for improving health. Patients' and physicians' reasons for ratings and improvement suggestions were coded into taxonomies developed from the data. Bivariate relationships between the variables and the difference between SRH and PRPH were examined and all single predictors of the difference were entered into a multivariable regression model.Results: Surveys were completed by 506 patients and 33 physicians. SRH and PRPH ratings matched exactly for 38% of the patient-physician dyads. Variables associated with SRH being lower than PRPH were higher patient body mass index (P ‫؍‬ .01), seeing the physician previously (P ‫؍‬ .04), older age, (P < .001), and a higher comorbidity score (P ‫؍‬ .001). Only 25.7% of the dyad reasons for health status rating and 24.1% of needed improvements matched, and these matches were unrelated to SRH/PRPH agreement. Physicians focused on disease in their reasoning for most patients, whereas patients with excellent or very good SRH focused on feeling well. Conclusions

A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation

“…General Overview: Patients' and clinicians' health beliefs frequently lack agreement, affirming the need for discussions about goals and shared decision-making with patients. 113 Many OMs make the theoretical assumption that all clients have similar goals leading to the challenge of capturing the unique goals of individual clients. 114 OMs have been developed, which allow the clinician and the patient to collaboratively and systematically establish individualized goals and reach agreement on the scaling of these goals.…”

“…Decision aid use to support shared decision-making has been shown to mildly increase (<3 minutes) the length of a patient's consultation with a health care provider. 113 When the results of OMs are not positive and/or patients have difficulty understanding the results, patients may experience stress/discomfort and the discussions may add time to the treatment session. Benefit-Harm Assessment: Preponderance of benefit.…”

“…Decision aid use to support shared decision-making has been shown to mildly increase (<3 minutes) the length of a patient's consultation with a health care provider. 113 …”

“…This is particularly important, as patients' and clinicians' health beliefs may lack agreement, confirming the need for shared decision-making between clinicians and patients. 113 …”

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“…Elder et al 12 explored patient and physician reasoning, as well as the roles played by patient lifestyle and objective health measures, in the congruence between patient self-rated health (SRH) and physician-rated patient health (PRPH). The patientphysician dyad reasons for health status rating and for needed health improvements matched approximately 25% of the time, yet these matches were not associated with SRH or PRPH.…”