title: Do older patients and their family caregivers agree about the quality of chronic illness care?
abstract: OBJECTIVE
  Family caregivers often accompany patients to medical visits; however, it is unclear whether caregivers rate the quality of patients' care similarly to patients. This study aimed to (1) quantify the level of agreement between patients' and caregivers' reports on the quality of patients' care and (2) determine how the level of agreement varies by caregiver and patient characteristics.
  
  
  METHODS
  Cross-sectional analysis.
  
  
  METHODS
  Multimorbid older (aged 65 and above) adults and their family caregivers (n = 247).
  
  
  METHODS
  Quality of care was rated separately by patients and their caregivers using the Patient Assessment of Chronic Illness Care (PACIC) instrument. The level of agreement was examined using a weighted kappa statistic (Kw).
  
  
  RESULTS
  Agreement of caregivers' and patients' PACIC scores was low (Kw = 0.15). Patients taking ten or more medications per day showed less agreement with their caregivers about the quality of care than patients taking five or fewer medications (Kw = 0.03 and 0.34, respectively, P < 0.05). Caregivers who reported greater difficulty assisting patients with health care tasks had less agreement with patients about the quality of care being provided when compared with caregivers who reported no difficulty (Kw = -0.05 and 0.31, respectively, P < .05). Patient-caregiver dyads had greater agreement on objective questions than on subjective questions (Kw = 0.25 and 0.15, respectively, P > 0.05).
  
  
  CONCLUSIONS
  Patient-caregiver dyads following a more complex treatment plan (i.e. taking many medications) or having more difficulty following a treatment plan (i.e. having difficulty with health care tasks) had less agreement. Future qualitative research is needed to elucidate the underlying reasons patients and caregivers rate the quality of care differently.
authors: National Committee for Quality Assurance, 1100 13th St. NW, Suite 2000, Washington, DC 20005, USA. giovannetti@ncqa.org.
authors: Erin R
authors: ER
authors: Giovannetti
authors: Lisa
authors: L
authors: Reider
authors: Jennifer L
authors: JL
authors: Wolff
authors: Kevin D
authors: KD
authors: Frick
authors: Chad
authors: C
authors: Boult
authors: Don
authors: D
authors: Steinwachs
authors: Cynthia M
authors: CM
authors: Boyd
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*
keywords: caregiver; primary care; quality of care
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