title: Convergence of health ratings across nephrologists, nurses, and patients with end-stage renal disease.
abstract: We evaluated a health rating for renal failure patients that was completed by patients, nurses, and nephrologists. The study was a prospective inception-cohort follow-up design. Measurements were taken before initiating dialysis (n=206) or at the initiation of dialysis (n=200) and at 18 (n=225), 30 (n=181), 42 (n=162), 54 (n=137), and 66 (n=112) months after initiating dialysis. Patients, nurses, and nephrologists independently rated patients' health at each measurement occasion. Objective measures of health status, abstracted from the medical record, included emergency and non-emergency admissions, smoking, diabetes mellitus, pulmonary edema, history and number of myocardial infarctions (MI), basal rales, comorbid illnesses, and uremic symptoms. Simultaneous multiple regression analyses examined the correspondence between objective measures of health status and subjective health ratings separately for each rater and measurement occasion. Health ratings were averaged and submitted to the same analyses. Raters showed good agreement (average Pearson r=.43 overall), although agreement was higher between nephrologists and nurses (average r=.64) than between health professional and patients (average r=.34 and .31, respectively). All three ratings and the combined rating corresponded significantly to objective measures of health status. Uremic symptoms, emergency hospital admissions, diabetes mellitus, and recent MI correlated uniquely and most consistently with subjective health ratings. Despite overall convergence, objective measures of health status related to the groups' ratings in a complementary fashion. The health rating is reliable and relates to the current status of the patient. Performance was superior for the combined score that incorporated ratings by patients, nurses, and nephrologists.
authors.affiliation: University Health Network, Toronto General Hospital, CW2-300, 200 Elizabeth Street, Toronto, M5G 2X4 Ontario, Canada. gdevins@uhnres.utoronto.ca
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Devins
authors.forename: Leendert C
authors.initials: LC
authors.lastname: Paul
authors.forename: Paul E
authors.initials: PE
authors.lastname: Barré
authors.forename: Henry
authors.initials: H
authors.lastname: Mandin
authors.forename: Kenneth
authors.initials: K
authors.lastname: Taub
authors.forename: Yitzchak M
authors.initials: YM
authors.lastname: Binik
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology; D017060:Patient Satisfaction; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics; D012044:Regression Analysis; D006435:Renal Dialysis; D015203:Reproducibility of Results