Physician-estimated disease severity in patients with chronic heart or lung disease: a cross-sectional analysis.
BACKGROUND
We evaluated how well physicians' global estimates of disease severity correspond to more specific physician-rated disease variables as well as patients' self-rated health and other patient variables.


METHODS
We analyzed baseline data from 1662 primary care patients with chronic cardiac or pulmonary disease who were enrolled in a longitudinal study of health-related quality of life (HRQoL). Each patient's primary physician rated overall disease severity, estimated the two-year risk of hospitalization and mortality, and reported the use of disease-specific medications, tests, and subspecialty referrals. Patient variables included sociodemographic characteristics, psychosocial factors, self-rated health, and both generic and disease-specific HRQoL.


RESULTS
Physicians rated 40% of their patients "about average", 30% "worse", and 30% "better" than the typical patient seen with the specific target disorder. The physician's global estimate of disease severity was strongly associated (P < 0.001) with each of the five more specific elements of physician-rated disease severity, but only marginally associated with patient self-rated health. Multivariable regression identified a set of patient variables that explained 16.4% of the variance in physician-rated disease severity.


CONCLUSIONS
Physicians' global ratings may provide disease severity and prognostic information unique from and complementary to patient self-rated health and HRQoL measures. The elements influencing physician-rated disease severity and its predictive validity for clinical outcomes warrant prospective investigation.
Kroenke
Kurt
K
Indiana University School of Medicine, Regenstrief Institute, 1059 Wishard Blvd, Indianapolis, IN 46202, USA. kkroenke@regenstrief.org
Wyrwich
Kathleen W
KW
Tierney
William M
WM
Babu
Ajit N
AN
Wolinsky
Fredric D
FD
D000328:Adult; D000368:Aged; D001249:Asthma / Q000503:physiopathology* / Q000523:psychology; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000503:physiopathology* / Q000523:psychology; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000523:psychology; D006760:Hospitalization; D006801:Humans; D007196:Indiana; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008923:Missouri; D011320:Primary Health Care / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D015203:Reproducibility of Results; D012649:Self Concept; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires