title: Discordance between physician-rated health and an objective health measure among institutionalized older people.
abstract: BACKGROUND
  Although physician-rated health is emerging as a potentially useful variable in research, with implications in practice, it has not been analyzed. Moreover, one of its most important aspects, namely, concordance with patients' objective health state, has not been investigated. This study sought to measure concordance between physician-rated health and an objective health measure, and assess both measures' validity in predicting death.
  
  
  METHODS
  The data for the study were drawn from a 1998-1999 survey and subsequent mortality follow-up of residential and nursing homes in Madrid (Spain). Study subjects were 630 residents aged ≥65 years, and their respective facility physicians. Measures included agreement between physicians' rating of residents' overall health (good, intermediate or poor) and an objective measure of residents' health (good, intermediate or poor), based on functional capacity, cognitive status, and number of chronic conditions. Overrating was defined as any case where health, rated as good by a physician, was objectively rated as poor.
  
  
  RESULTS
  Whereas 45% of physicians and 55% of residents rated their health as good, only 4% of such residents had good objective health. Of those who received a physician rating of good/very good health, 39.0% had poor objective health. There was evidence of clear overrating in 18% of the population, and clear to moderate overrating in 73% of the population. In terms of power to predict mortality, the pattern of behavior shown by the objective health measure was good, graded and congruent, and better than that shown by physician-rated health.
  
  
  CONCLUSIONS
  Physician overrating of the overall health of older persons in residential and nursing homes, would appear to be very high. Although some degree of contextualization by physicians in this setting might be considered reasonable, the degree of overrating in our population seems nevertheless excessive.
authors.affiliation: National Center for Epidemiology, Carlos III Institute of Health, Av/ Monforte de Lemos 5, 28029, Madrid, Spain. jdamian@isciii.es.|Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Madrid, Spain. jdamian@isciii.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Damián
authors.affiliation: National Center for Epidemiology, Carlos III Institute of Health, Av/ Monforte de Lemos 5, 28029, Madrid, Spain. rpastor@isciii.es.|Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain. rpastor@isciii.es.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pastor-Barriuso
authors.affiliation: "Arroyo de la Media Legua" Primary Care Center, Madrid Health Service (Servicio Madrileño de Salud), Madrid, Spain. emivgmed@yahoo.es.
authors.forename: Emiliana
authors.initials: E
authors.lastname: Valderrama-Gama
authors.affiliation: National Center for Epidemiology, Carlos III Institute of Health, Av/ Monforte de Lemos 5, 28029, Madrid, Spain. jpedro@isciii.es.|Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Madrid, Spain. jpedro@isciii.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: de Pedro-Cuesta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059026:Diagnostic Self Evaluation; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006305:Health Status Indicators; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010820:Physicians; D015203:Reproducibility of Results; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires