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01-09-2016 | Uitgave 9/2016

Quality of Life Research 9/2016

Quantifying clinical change: discrepancies between patients’ and providers’ perspectives

Tijdschrift:
Quality of Life Research > Uitgave 9/2016
Auteurs:
Rachel P. Dreyer, Philip G. Jones, Shelby Kutty, John A. Spertus
Belangrijke opmerkingen

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11136-016-1267-9) contains supplementary material, which is available to authorized users.

Abstract

Purpose

Interpreting the clinical significance of changes in patient-reported outcomes (PROs) is critically important. The most commonly used approach is to anchor mean changes on PRO scores against a global assessment of change. Whether the assessor of global change should be patients or their physicians is unknown. We compared patients’ and physicians’ assessments of change over time to examine which was more aligned with patients’ changes in PRO measures.

Methods

A total of 459 chronic heart failure patients aged >30 years were enrolled from 13 US centers. Data were obtained by medical record abstraction, physical assessments, and patient interviews at a baseline clinic visit and 6 weeks later. Health status was measured with the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ), and both patients and physicians completed a validated 15-level global assessment of change, ranging from large deterioration to large improvement.

Results

There was substantial variation between physicians/patients’ global assessment of clinical change (weighted kappa = 0.36, 95 % CI 0.28, 0.43). Overall, physician assessments were more strongly correlated with change on the KCCQ summary score than were patients’ assessments (physician R = 0.37, patient R = 0.29).

Conclusion

There was substantial variation between patients’ and physicians’ global assessment of 6-week change in heart failure status. Physician assessments of the importance of clinical changes were more strongly associated with changes in all domains of patient-reported health status, as assessed by the KCCQ, and may provide a more consistent method for defining the clinical importance of changes in patients’ health status.

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Extra materiaal
Supplementary material 1 (DOCX 1854 kb)
11136_2016_1267_MOESM1_ESM.docx
Literatuur
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