[Patient-centered evaluation of the health status in a longitudinal quality management system in the hospital].
OBJECTIVE
The objective was to assess the value of self-reported health status as an indicator of outcomes of acute hospital care, to identify potential practical limitations, and develop strategies for future applications.


METHODS
180 patients from 4 acute care hospitals in Germany participated in a comprehensive and longitudinal assessment of outcome of care in general internal medicine between 8/1/99 and 10/31/99. Self-administered SF-36 surveys were completed at admission and 4 weeks after discharge. Additionally, nurses and physicians answered questions regarding the patients' health status. Linear relations between health status assessments were quantified as correlation coefficients. Odds ratios (OR) and 95% confidence limits from multivariate logistic regression models were reported for predictors of non-returned questionnaires.


RESULTS
33% of SF-36 surveys handed out at discharge were returned. Patients with impairments and referred patients were more likely not to return the survey (OR = 1.3 [1.09; 1.66] and OR = 3.7 [1.37; 9.87]). The linear relation of SF-36 and SF-12 scores in the same patients were r = 0.95 [0.91; 0.97] for physical health and r = 0.91 [0.85; 0.94] for mental health. Physicians and nurses moderately agreed in their assessment of patients' health (r = 0.38 [0.22; 0.52]) but both professional groups showed poor agreement with self-reported health (r = 0.15 [-0.08; 0.36] and r = -0.01 [-0.23; 0.21]).


CONCLUSIONS
1. Self-reported health status should be considered in the assessment of outcomes of acute care as a dimension that is to some extent independent of health status assessment by professionals, 2. shorter instruments, i.e., the SF-12, can be used instead of the SF-36, 3. a self-reported health status assessment is feasible 4 weeks after discharge, and 4. patients with multiple impairments or those who are transferred should get specific support in the completion of questionnaires to increase response or to receive at least minimal information about their health status.
Schneeweiss
S
S
Harvard Medical School, Boston, USA. schneeweiss@post.harvard.edu
Sangha
O
O
Manstetten
A
A
D000368:Aged; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D005858:Germany; D006305:Health Status Indicators; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D017060:Patient Satisfaction; D012017:Referral and Consultation; D012647:Self-Assessment; D017749:Total Quality Management