Quantifying clinical change: discrepancies between patients' and providers' perspectives

Area of Science:

• Cardiology
• Health Outcomes Research
• Clinical Evaluation

Background:

• Interpreting changes in patient-reported outcomes (PROs) is crucial for clinical decision-making.
• Anchoring PRO score changes to global assessments of change is a common practice.
• The optimal assessor for global change—patient or physician—remains unclear.

Purpose of the Study:

• To compare patient and physician global assessments of change over time.
• To determine which assessment aligns better with changes in PRO measures.
• To evaluate the consistency of physician versus patient global change assessments in chronic heart failure.

Main Methods:

• 459 chronic heart failure patients from 13 US centers were enrolled.
• Data collected at baseline and 6-week follow-up included medical records, physical assessments, and patient interviews.
• Kansas City Cardiomyopathy Questionnaire (KCCQ) measured health status; patients and physicians completed a 15-level global assessment of change.

Main Results:

• Significant variation existed between patient and physician global change assessments (weighted kappa = 0.36).
• Physician assessments showed a stronger correlation with changes in the KCCQ summary score (R=0.37) compared to patient assessments (R=0.29).
• Physician assessments were more strongly associated with changes across all KCCQ domains.

Conclusions:

• Substantial disagreement exists between patient and physician global assessments of 6-week change in heart failure status.
• Physician assessments of clinical change appear more consistently associated with patient-reported health status changes.
• Physician assessments may offer a more reliable method for defining the clinical importance of health status changes in heart failure patients.