Predictors of doctor-rated and patient-rated gout severity: gout impact scales improve assessment.
OBJECTIVE
Our objective was to describe the factors associated with doctor-rated and patient-rated gout severity to explain how doctor assessment involving patient-reported outcomes can improve the clinical management of gout.


METHODS
Patients completed a newly validated gout-specific health-related quality of life instrument, the Gout Impact Scale (GIS) and other questions regarding their gout. Both patients and their doctors gave an overall gout severity assessment. We conducted correlation analyses between each predictor of interest and the two different severity ratings (doctor-rated severity and patient-rated severity). Stepwise multiple regressions were performed to determine the best predictors for doctor-rated and patient-rated severity, respectively.


RESULTS
Doctor-rated severity more closely correlated with objective clinical and laboratory findings, particularly the presence of tophi, which was not a leading factor in patient-rated severity assessments. Patient-rated severity more closely correlated with the domains of the GIS, which expressed the impact of gout on health-related quality of life.


CONCLUSIONS
Doctors might have a better understanding of their patients' level of disease impact if they incorporate an instrument such as the GIS in their evaluation of gout severity and their decisions regarding aggressiveness of treatment. The increased use of patient-reported outcomes measures has the potential to improve quality of care and patient satisfaction, as well as reduce costs of health care utilization.
Sarkin
Andrew J
AJ
Health Services Research Center, University of California, San Diego, California, USA. asarkin@ucsd.edu
Levack
Ashley E
AE
Shieh
Marian M
MM
Kavanaugh
Arthur F
AF
Khanna
Dinesh
D
Singh
Jasvinder A
JA
Terkeltaub
Robert A
RA
Lee
Susan J
SJ
Hirsch
Jan D
JD
D000368:Aged; D005260:Female; D006073:Gout / Q000503:physiopathology*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000295:instrumentation*; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index; D014481:United States