title: Is patient-perceived severity of a geriatric condition related to better quality of care?
abstract: BACKGROUND
  Care for falls and urinary incontinence (UI) among older patients is inadequate. One possible explanation is that physicians provide less recommended care to patients who are not as concerned about their falls and UI.
  
  
  OBJECTIVE
  To test whether patient-reported severity for 2 geriatric conditions, falls, and UI, is associated with quality of care.
  
  
  METHODS
  Prospective cohort study of elders with falls and/or fear of falling (n = 384) and UI (n = 163).
  
  
  METHODS
  Participants in the Assessing Care of Vulnerable Elders-2 Study (2002-2003), which evaluated an intervention to improve the care for falls and UI among older (age, ≥ 75) ambulatory care patients with falls/fear of falling or UI.
  
  
  METHODS
  Falls Efficacy Scale (FES) and the Incontinence Quality of Life surveys measured at baseline, quality of care measured by a 13-month medical record abstraction.
  
  
  RESULTS
  There was a small difference in falls quality scores across the range of FES, with greater patient-perceived falls severity associated with better odds of passing falls quality indicators (OR: 1.11 [95% CI: 1.02-1.21] per 10-point increment in FES). Greater patient-perceived UI severity (Incontinence Quality of Life score) was not associated with better quality of UI care.
  
  
  CONCLUSIONS
  Although older persons with greater patient-perceived falls severity receive modestly better quality of care, those with more distressing incontinence do not. For both conditions, however, even the most symptomatic patients received less than half of recommended care. Low patient-perceived severity of condition is not the basis of poor care for falls and UI.
authors.affiliation: Department of Medicine, Division of Geriatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA. lmin@med.umich.edu
authors.forename: Lillian C
authors.initials: LC
authors.lastname: Min
authors.forename: David B
authors.initials: DB
authors.lastname: Reuben
authors.forename: Emmett
authors.initials: E
authors.lastname: Keeler
authors.forename: David A
authors.initials: DA
authors.lastname: Ganz
authors.forename: Constance H
authors.initials: CH
authors.lastname: Fung
authors.forename: Paul
authors.initials: P
authors.lastname: Shekelle
authors.forename: Carol P
authors.initials: CP
authors.lastname: Roth
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D010361:Patients / Q000523:psychology*; D010465:Perception; D010817:Physician-Patient Relations; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care; D011788:Quality of Life; D012720:Severity of Illness Index; D014549:Urinary Incontinence / Q000175:diagnosis