Discordance between physician-rated health and an objective health measure among institutionalized older people

BMC Geriatrics

Jesús de Pedro-Cuesta²  Emiliana Valderrama-Gama³  Roberto Pastor-Barriuso¹  Javier Damián² 

[1] Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain;Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Madrid, Spain;“Arroyo de la Media Legua” Primary Care Center, Madrid Health Service (Servicio Madrileño de Salud), Madrid, Spain

关键词: Older people;    Mortality;    Nursing homes;    Quality of care;    Health assessment;   

Others  :  1218271
DOI  :  10.1186/s12877-015-0074-4

 received in 2015-02-09, accepted in 2015-06-15,  发布年份 2015

【 摘 要 】

Background

Although physician-rated health is emerging as a potentially useful variable in research, with implications in practice, it has not been analyzed. Moreover, one of its most important aspects, namely, concordance with patients’ objective health state, has not been investigated. This study sought to measure concordance between physician-rated health and an objective health measure, and assess both measures’ validity in predicting death.

Methods

The data for the study were drawn from a 1998–1999 survey and subsequent mortality follow-up of residential and nursing homes in Madrid (Spain). Study subjects were 630 residents aged ≥65 years, and their respective facility physicians. Measures included agreement between physicians’ rating of residents’ overall health (good, intermediate or poor) and an objective measure of residents’ health (good, intermediate or poor), based on functional capacity, cognitive status, and number of chronic conditions. Overrating was defined as any case where health, rated as good by a physician, was objectively rated as poor.

Results

Whereas 45 % of physicians and 55 % of residents rated their health as good, only 4 % of such residents had good objective health. Of those who received a physician rating of good/very good health, 39.0 % had poor objective health. There was evidence of clear overrating in 18 % of the population, and clear to moderate overrating in 73 % of the population. In terms of power to predict mortality, the pattern of behavior shown by the objective health measure was good, graded and congruent, and better than that shown by physician-rated health.

Conclusion

Physician overrating of the overall health of older persons in residential and nursing homes, would appear to be very high. Although some degree of contextualization by physicians in this setting might be considered reasonable, the degree of overrating in our population seems nevertheless excessive.

【 授权许可】

   
2015 Damián et al.

【 图 表 】

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【 参考文献 】

• [1]Jylha M: What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 2009, 69:307-316.
• [2]Kivinen P, Halonen P, Eronen M, Nissinen A: Self-rated health, physician-rated health and associated factors among elderly men: the Finnish cohorts of the Seven Countries Study. Age Ageing 1998, 27:41-47.
• [3]Geest TA, Engberg M, Lauritzen T: Discordance between self-evaluated health and doctor-evaluated health in relation to general health promotion. Scand J Prim Health Care 2004, 22:146-151.
• [4]Desalvo KB, Muntner P: Discordance between physician and patient self-rated health and all-cause mortality. Ochsner J 2011, 11:232-240.
• [5]Giltay EJ, Vollaard AM, Kromhout D: Self-rated health and physician-rated health as independent predictors of mortality in elderly men. Age Ageing 2012, 41:165-171.
• [6]Todd MA, Goldman N: Do interviewer and physician health ratings predict mortality? A comparison with self-rated health. Epidemiology 2013, 24:913-920.
• [7]Wilper AP, Woolhandler S, Lasser KE, McCormick D, Bor DH, Himmelstein DU: Health insurance and mortality in US adults. Am J Public Health 2009, 99:2289-2295.
• [8]Moor C, Zimprich D, Schmitt M, Kliegel M: Personality, aging self-perceptions, and subjective health: a mediation model. Int J Aging Hum Dev 2006, 63:241-257.
• [9]Shah S, Vanclay F, Cooper B: Improving the sensitivity of the Barthel index for stroke rehabilitation. J Clin Epidemiol 1989, 42:703-709.
• [10]Pfeiffer E: A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975, 23:433-441.
• [11]Gruber-Baldini AL, Zimmerman SI, Mortimore E, Magaziner J: The validity of the minimum data set in measuring the cognitive impairment of persons admitted to nursing homes. J Am Geriatr Soc 2000, 48:1601-1606.
• [12]Hartmaier SL, Sloane PD, Guess HA, Koch GG: The MDS Cognition Scale: a valid instrument for identifying and staging nursing home residents with dementia using the Minimum Data Set. J Am Geriatr Soc 1994, 42:1173-1179.
• [13]Health Information Institute. National Death Index-Access Request. https://www.msssi.gob.es/en/estadEstudios/estadisticas/estadisticas/estMinisterio/IND_TipoDifusion.htm. 26-9-2014. Madrid. Spain, IND Monitoring Technical Committee Secretary. Ministry of Health, Social Services and Equality. 4-11-2014.
• [14]StataCorp: Stata Statistical Software: Release 13. Stata Corp LP, College Station, TX; 2013.
• [15]Damián J, Pastor-Barriuso R, Valderrama-Gama E: Factors associated with self-rated health in older people living in institutions. BMC Geriatr 2008, 8:5. BioMed Central Full Text
• [16]Damián J, Ruigómez A, Pastor V, Martin-Moreno JM: Determinants of self assessed health among Spanish older people living at home. J Epidemiol Community Health 1999, 53:412-416.
• [17]Kroenke K, Wyrwich KW, Tierney WM, Babu AN, Wolinsky FD: Physician-estimated disease severity in patients with chronic heart or lung disease: a cross-sectional analysis. Health Qual Life Outcomes 2006, 4:60. BioMed Central Full Text
• [18]Chatterji S, Byles J, Cutler D, Seeman T, Verdes E: Health, functioning, and disability in older adults–present status and future implications. Lancet 2015, 385:563-575.
• [19]Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MV: Studies of illness in the aged. The index of ADL. A standardized measure of biological and psychological function. JAMA 1963, 185:914-919.
• [20]Folstein MF, Folstein SE, McHugh PR: “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12:189-198.