title: Association of patient-centered outcomes with patient-reported and ICD-9-based morbidity measures.
abstract: OBJECTIVE
  Evaluating patient-centered care for complex patients requires morbidity measurement appropriate for use with a variety of clinical outcomes. We compared the contributions of self-reported morbidity and morbidity measured using administrative diagnosis data for both patient-reported outcomes and utilization outcomes.
  
  
  METHODS
  Using a cohort of 961 persons aged 65 years or older with 3 or more medical conditions, we explored 9 health outcomes as a function of 4 independent variables representing different types of morbidity measures: International Classification of Diseases, Ninth Revision (ICD-9), a self-reported weighted count of conditions, and self-reported symptoms of depression and of anxiety. Outcomes varied from self-reported health status to utilization. Depending on the outcome measure, we used multivariate linear, negative binomial, or logistic regression, adjusting for demographic characteristics and length of enrollment to assess associations between dependent and all 4 independent variables.
  
  
  RESULTS
  Higher morbidity measured by ICD-9 diagnoses was independently associated with less favorable levels of 7 of the 9 clinical outcomes. Higher self-reported disease burden was significantly associated with less favorable levels of 8 of the outcomes, controlling for the 3 other morbidity measures. Morbidity measured by diagnosis code was more strongly associated with higher utilization, whereas self-reported disease burden and emotional symptoms were more strongly associated with patient-reported outcomes.
  
  
  CONCLUSIONS
  A comprehensive assessment of morbidity requires both subjective and objective measurement of disease burden as well as an assessment of emotional symptoms. Such multidimensional morbidity measurement is particularly relevant for research or quality assessments involving the delivery of patient-centered care to complex patient populations.
authors.affiliation: Institute for Health Research, Kaiser Permanente, Denver, Colorado 80231-5968, USA. elizabeth.bayliss@kp.org
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bayliss
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ellis
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Shoup
authors.forename: Chan
authors.initials: C
authors.lastname: Zeng
authors.forename: Deanna B
authors.initials: DB
authors.lastname: McQuillan
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D009017:Morbidity; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D057566:Self Report