title: Clinical significance of physical symptom severity in standardized assessments of patient reported outcomes.
abstract: Standardized measures of physical symptoms predict mortality and healthcare utilization, but clinicians remain uncertain about how to apply them in routine clinical care. Recognizing the tendency for physician documentations to routinely underestimate symptom burden, we assessed whether or not severity was an important dimension of symptom assessments that may determine their usefulness in clinical encounters.
  
  
  
  Retrospective cohort study using data from audio computer-assisted self-interviews augmented by chart review of patients from a primary care clinic of an urban health system.
  
  
  
  We sampled 145 patients who completed the Memorial Symptom Assessment Scale (MSAS) short form-physical symptom severity measurement-before their primary care visit. Most were women (60 %), and non-Hispanic black (59 %), and many responded in Spanish (19 %). All but three reported > 1 symptom. Overall, 79 % of elicited symptoms were not documented in physician notes from the same day. Severe symptoms were more likely to be documented [MSAS mean (95 % confidence interval): documented 2.2 (1.9, 2.4) vs. undocumented 1.8 (1.7, 1.9)].
  
  
  
  Documentations reflect usual patient-clinician communications that prioritize severe symptoms, while standardized instruments target their comprehensive assessments. Among the many validated instruments, those eliciting the severity of physical symptoms may simultaneously help clinicians with prioritization and risk assessments.
authors.affiliation: Department of Medicine, John Stroger Hospital, Chicago, IL, 60612, USA. khinami@cookcountyhhs.org.|Collaborative Research Unit, Cook County Health and Hospitals System, Chicago, IL, USA. khinami@cookcountyhhs.org.
authors.forename: Keiki
authors.identifier: 0000-0002-1927-2546
authors.initials: K
authors.lastname: Hinami
authors.affiliation: Department of Medicine, John Stroger Hospital, Chicago, IL, 60612, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alkhalil
authors.affiliation: Department of Medicine, John Stroger Hospital, Chicago, IL, 60612, USA.
authors.forename: Sonam
authors.initials: S
authors.lastname: Chouksey
authors.affiliation: Department of Medicine, John Stroger Hospital, Chicago, IL, 60612, USA.
authors.forename: Jacquelin
authors.initials: J
authors.lastname: Chua
authors.affiliation: Department of Medicine, John Stroger Hospital, Chicago, IL, 60612, USA.|Collaborative Research Unit, Cook County Health and Hospitals System, Chicago, IL, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Trick
mesh_terms: D000368:Aged; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D010808:Physical Examination; D011320:Primary Health Care; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D063189:Symptom Assessment / Q000379:methods*
keywords: Audio computer-assisted self-interview technology; Patient reported outcomes; Primary care; Quality of life